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Objective . One out of three stroke-patients develop language processing impairment known as aphasia. The need for ecological validity of the existing diagnostic tools motivates research on biomarkers, such as stimulus-evoked brain responses. With the aim of enhancing the physiological interpretation of the latter, we used EEG to investigate how functional brain network patterns associated with the neural response to natural speech are affected in persons with post-stroke chronic aphasia. Approach . EEG was recorded from 24 healthy controls and 40 persons with aphasia while they listened to a story. Stimulus-evoked brain responses at all scalp regions were measured as neural envelope tracking in the delta (0.5-4 Hz), theta (4-8 Hz) and low-gamma bands (30-49 Hz) using mutual information. Functional connectivity between neural-tracking signals was measured, and the Network-Based Statistics toolbox was used to: (1) assess the added value of the neural tracking vs EEG time series, (2) test between-group differences and (3) investigate any association with language performance in aphasia. Graph theory was also used to investigate topological alterations in aphasia. Main results . Functional connectivity was higher when assessed from neural tracking compared to EEG time series. Persons with aphasia showed weaker low-gamma-band left-hemispheric connectivity, and graph theory-based results showed a greater network segregation and higher region-specific node strength. Aphasia also exhibited a correlation between delta-band connectivity within the left pre-frontal region and language performance. Significance. We demonstrated the added value of combining brain connectomics with neural-tracking measurement when investigating natural speech processing in post-stroke aphasia. The higher sensitivity to language-related brain circuits of this approach favors its use as informative biomarker for the assessment of aphasia., (© 2024 IOP Publishing Ltd. All rights, including for text and data mining, AI training, and similar technologies, are reserved.)

Purpose: Assessing fluency in aphasia is diagnostically important for determining aphasia type and severity and therapeutically important for determining appropriate treatment targets. However, wide variability in the measures and criteria used to assess fluency, as revealed by a recent survey of clinicians (Gordon & Clough, 2022), results in poor reliability. Furthermore, poor specificity in many fluency measures makes it difficult to identify the underlying impairments. Here, we introduce the Flu-ID Aphasia, an evidence-based tool that provides a more informative method of assessing fluency by capturing the range of behaviors that can affect the flow of speech in aphasia., Method: The development of the Flu-ID was based on prior evidence about factors underlying fluency (Clough & Gordon, 2020; Gordon & Clough, 2020) and clinical perceptions about the measurement of fluency (Gordon & Clough, 2022). Clinical utility is maximized by automated counting of fluency behaviors in an Excel template. Reliability is maximized by outlining thorough guidelines for transcription and coding. Eighteen narrative samples representing a range of fluency were coded independently by the authors to examine the Flu-ID's utility, reliability, and validity., Results: Overall reliability was very good, with point-to-point agreement of 86% between coders. Ten of the 12 dimensions showed good to excellent reliability. Validity analyses indicated that Flu-ID scores were similar to clinician ratings on some dimensions, but differed on others. Possible reasons and implications of the discrepancies are discussed, along with opportunities for improvement., Conclusions: The Flu-ID assesses fluency in aphasia using a consistent and comprehensive set of measures and semi-automated procedures to generate individual fluency profiles. The profiles generated in the current study illustrate how similar ratings of fluency can arise from different underlying impairments. Supplemental materials include an analysis template, extensive guidelines for transcription and coding, a completed sample, and a quick reference guide., Supplemental Material: https://doi.org/10.23641/asha.27078199.

Purpose: The current study delineated a clinical and theoretical framework that clinicians and researchers can use to guide the assessment of bilingual aphasia at morphosyntactic, lexical-semantic, and phonological levels of language processing., Method: This tutorial outlines cross-linguistic and multicultural considerations that should be addressed in evaluating bilingual adults with aphasia (BWAs)., Results: At the morphosyntactic level, we presented three features that should be taken into account when evaluating linguistic symptoms in languages considering whether they are typologically similar or dissimilar: word order, pro(noun)-drop, and morphological inflections of verbs. We suggest that clinicians need to conduct additional error analyses that reflect typological differences in syntactic templates, argument-deletion phenomena, and morphological inflections to better understand linguistic characteristics of impairments arising from the interactions of the two languages that may differ in many ways. At the lexical-semantic level, we addressed three cross-linguistic features that may impact naming performance in BWAs: cognates, lexical frequency, and semantic typicality. The presence of cognates between the two languages can lead to differential interpretations of naming performance. In addition, the same lexical items may exhibit varying lexical frequency and typicality across languages due to cultural and linguistic differences. We suggest that clinicians should thoroughly prepare the testing items considering the linguistic distance. Finally, we emphasized differences in segmental and suprasegmental features of phonology that could contribute to cross-linguistic phenomena during assessment of two or more languages., Conclusions: This cross-linguistic assessment framework contributes to a better understanding of linguistic impairments and communication difficulties experienced by BWAs. This framework can be utilized in current clinical practice to facilitate culturally and linguistically appropriate assessment and treatment approaches for BWAs.

Background & Aims: Studies using eye-tracking methodology have made important contributions to the study of language disorders such as aphasia. Nevertheless, in clinical groups especially, eye-tracking studies often include small sample sizes, limiting the generalizability of reported findings. Online, webcam-based tracking offers a potential solution to this issue, but web-based tracking has not been compared with in-lab tracking in past studies and has never been attempted in groups with language impairments., Materials & Methods: Patients with post-stroke aphasia (n = 16) and age-matched controls (n = 16) completed identical sentence-picture matching tasks in the lab (using an EyeLink system) and on the web (using WebGazer.js), with the order of sessions counterbalanced. We examined whether web-based eye tracking is as sensitive as in-lab eye tracking in detecting group differences in sentence processing., Results: Patients were less accurate and slower to respond to all sentence types than controls. Proportions of gazes to the target and foil picture were computed in 100 ms increments, which showed that the two modes of tracking were comparably sensitive to overall group differences across different sentence types. Web tracking showed comparable fluctuations in gaze proportions to target pictures to lab tracking in most analyses, whereas a delay of approximately 500-800 ms appeared in web compared to lab data., Discussion & Conclusions: Web-based eye tracking is feasible to study impaired language processing in aphasia and is sensitive enough to detect most group differences between controls and patients. Given that validations of webcam-based tracking are in their infancy and how transformative this method could be to several disciplines, much more testing is warranted., (© 2024 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

Background: The abbreviated version of the Token Test (aTT) is widely used to assess language comprehension deficits in stroke patients (SPs). However, aTT has not been validated for Latin American Spanish speakers, so clinicians tend to use cut-off scores for aTT validated in developed countries., Aims: To provide normative data for the Spanish aTT (Sp-aTT) in healthy Chilean Spanish-speaking and SP, determining the influence of sociodemographic variables such as gender, age and education on Sp-aTT performance., Methods & Procedures: A total of 210 healthy volunteers (age range = 18-88 years) and 197 SPs (age range = 23-94 years), all native speakers of Chilean Spanish, were recruited. The association of age, gender and years of education on the Sp-aTT performance was analysed. Specificity and sensibility analyses of the Sp-aTT to diagnose language comprehension deficits were completed., Outcomes & Results: Only age (p < 0.001) and years of education (p < 0.001) impacted the total score of Sp-aTT. Gender did not show an association with Sp-aTT performance (p = 0.181). For SPs, the Sp-aTT score showed a significant positive correlation (rho = 0.4, p < 0.001) with the aphasia severity rating scale (ASRS) score. For Sp-aTT, the area under the curve was 0.97, and the optimal cut-off score for the Sp-aTT was 30 (0.73 of sensitivity, 0.92 of specificity and a Youden index of 0.644)., Conclusions & Implications: Age and years of education are two key factors to be controlled for when determining the optimal cut-off points for the Sp-aTT. Our results also highlight the need for language-specific norms in stroke and aphasia research., What This Paper Adds: What is already known on the subject The aTT has been validated and adapted in several countries. Its properties in screening and detecting comprehensive deficits in SPs highlight its potential as a screening tool in clinical practice. Moreover, considering that stroke is the third largest cause of death worldwide, research and clinical practice have focused on how to improve early detection of deficits in these people, especially those related to cognition, language and functionality in SPs. Therefore, counting with validated and adapted tools is essential for clinicians because it could contribute to accurate intervention and classification of language disorders. What this paper adds to the existing knowledge The main contribution of this study is to provide normative data for the aTT in Latin American Spanish speakers. No previous studies have focused on validating this test and analysing the influence of three critical variables (age, gender and years of education) on its performance in SPs from Latin America. In addition, we propose a classification of the severity of comprehension deficits in SPs. Finally, we found comprehension deficits in patients with right and left hemisphere stroke, which would imply that these deficits would not be exclusive to left hemisphere stroke. What are the potential or actual clinical implications of this work? Contribute with validation of language comprehension tools, such as the aTT, could improve early diagnosis of patients with language disorders. This validation provides a test based on the sociodemographic characteristics of Latin American Speakers, which has yet to be established. Due to this, normative data considering the sociodemographic characteristics of the target population is crucial for accurately classifying comprehension deficits after brain damage., (© 2024 The Author(s). International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Objective: Limited normative data (including psychometric properties) are currently available on discourse tasks in non-dominant languages such as Laurentian (Quebec) French. The lack of linguistic and cultural adaptation has been identified as a barrier to discourse assessment. The main aim of this study is to document inter-rater and test-retest reliability properties of the picnic scene of the Western Aphasia Battery - Revised (WAB-R), including the cultural adaptation of an information content unit (ICU) list, and provide a normative reference for persons without brain injury (PWBI). Method: To do so, we also aimed to adapt an ICU checklist culturally and linguistically for Laurentian French speakers. Discourse samples were collected from 66 PWBI using the picture description task of the WAB-R. The ICU list was first adapted into Laurentian French. Then, ICUs and thematic units (TUs) were extracted manually, and microstructural variables were extracted using CLAN. Inter-rater reliability and test-retest reliability were determined. Results: Excellent inter-rater reliability was obtained for ICUs and TUs, as well as for all microstructural variables, except for mean length of utterance, which was found to be good. Conversely, test-retest reliability ranged from poor to moderate for all variables. Conclusion: The present study provides a validated ICU checklist for clinicians and researchers working with Laurentian French speakers when assessing discourse with the picnic scene of the WAB-R. It also addresses the gap in available psychometric data regarding inter-rater and test-retest reliability in PWBI.

Background: Accessibility of data visualization has been explored for users with visual disabilities but the needs of users with language disabilities have seldom been considered., Aim: This scoping review synthesised what is known about data visualization for adults with language disabilities, specifically the acquired language disability, aphasia and Developmental Language Disorder. It sought to extract key findings and identify what practices support effective visualization for decision making for people with language disabilities., Method: Papers were included if they investigated visualization of data, and the consumers of the data visualization were people with aphasia or developmental language disability. Seven databases were searched: CINAHL, Academic Search, Medline, PsychINFO, Ovid, ACM Digital Library and IEEE Xplore. Included studies were charted to extract title, author(s), year, country, paper type, scientific field, participant number(s), participant group(s), main topic, subtopic, method, task description, task category, data visualization, summary, key findings relevant to the review question, and guidelines or recommendations. Narrative synthesis was used to describe how people with language disability have interacted with data visualization from a range of literature., Main Contribution: Six studies (seven publications) were included in the review. One study came from the field of health, one from a disability rights collaboration and four studies from computer science. No studies satisfying the review criteria explored data visualization for Developmental Language Disorder; however, five studies explored participants with cognitive disabilities that included impairments of language, so these were included. A range of visualization designs were found. Studies predominantly explored understanding of visualization (4/6). One study explored how to express data visually, and one explored the use of the visualization that is, for an action, choice, or decision. Cognitively accessible data visualization practices were described in four papers and synthesized. Supportive practices reported were reducing the cognitive load associated with processing a visualization and increasing personal relevance of data visualization., Conclusion: Accessible data visualization for adults with aphasia and Developmental Language Disorder has only minimally been explored. Practices to specifically support users with language disability are not yet apparent. As data use in making everyday decisions is widespread, future research should explore how people with language disabilities make use of data visualization., What This Paper Adds: What is already known on this subject Visual resources are used widely to support people with language disabilities in understanding of language. That is, icons, maps timelines and so forth, are used to support auditory processing. However, data visualization is used routinely by people without a language disability to support everyday decisions for example, visualization of live traffic data is used to provide users with the best route to their destination. It is unclear whether any work has explored data visualization for people with language disabilities.  What this paper adds to existing knowledge This paper brings together research on the use of data visualization by adults with either Developmental Language Disorder or aphasia, collectively people with language disabilities. It highlights a gap in the design of inclusive data visualization for language disabilities and the minimal research exploring the use of data visualization for decision making in these populations. What are the clinical implications of this work? Access to data can be empowering. It has potential to enable agency in decisions and increase social participation. The existing gap in knowledge about how to design inclusive data visualization for people with language disabilities thus poses a risk of exclusion and threats to informed decision making. Highlighting the current field of literature may drive research and clinical activity., (© 2024 The Author(s). International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

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

Background: The use of self-report pain scales in persons with aphasia can be challenging due to communication and cognitive problems, while for assessing pain self-report pain is considered the gold standard (Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis. 2015;39(3-4):190-201.). An observational scale may be used as an alternative. This study examines the validity and reliability of the observational Pain Assessment in Impaired Cognition (PAIC15) scale in persons with aphasia., Methods: Persons with aphasia were observed during rest and transfer by two observers using the PAIC15. The PAIC15 comprises 15 items covering the three domains of facial expressions, body movements, and vocalizations. When able, the participant completed four self-report pain scales after each observation. The observations were repeated within one week. For criterion validity, correlations between the PAIC15 and self-report pain scales were calculated and for construct validity, three hypotheses were tested. Reliability was determined by assessing internal consistency, and intra- and interobserver agreement., Results: PAIC15 observations were obtained for 71 persons (mean age 75.5 years) with aphasia. Fair positive correlations (rest: 0.35-0.50; transfer: 0.38-0.43) were reported between PAIC15 and almost all self-report pain scales. Results show that significantly more pain was observed in persons with aphasia during transfer than during rest. No differences were found for observed pain between persons with aphasia who use pain medication and those without, or persons who have joint diseases compared to those without. Results showed acceptable internal consistency. Intra- and interobserver agreement was high for most PAIC15 items, particularly for the domains body movements and vocalizations during rest and transfer., Conclusions: Recognition of pain in persons aphasia using the PAIC15 showed mixed yet promising results., (© 2024. The Author(s).)

Purpose: This study synthesizes participant and outcome data from peer-reviewed Intensive Comprehensive Aphasia Programme (ICAP) studies., Methods: A systematic review was conducted following PRISMA guidelines. Study eligibility criteria were specified in relation to population, intervention, comparison, outcome, and design considerations. Data were extracted according to six research questions. Narrative synthesis was used., Results: Twenty-one studies were included covering 13 ICAPs ( N  = 485, aged 18-86 years, between 11 and 335 months post-stroke). Twenty-seven participant selection criteria were identified. Fifty-six outcome measures spanning the WHO-ICF were used, with the majority assessing the body function domain. Only eight studies employed an experimental design with data appropriate for analysis and synthesis. Risk of bias was noted across this sub-group. Participants improved in word-finding, communication, activity/participation, and communication-related quality of life, and maintained their gains; however, except for word finding, evidence of effect came from isolated studies. Factors influencing outcomes were rarely considered. Some drop-outs, missed sessions, and fatigue were noted. Some studies reported IPD alongside group analyses., Conclusions: ICAP selection criteria need justification and should contribute to the understanding of candidacy for this treatment model. Rationalisation of ICAP treatment content and outcome measurement is required, spanning all WHO-ICF domains. Employment of the core outcome set for aphasia would enable data synthesis and facilitate comparisons between the ICAP and other therapy models.

Aphasia constitutes a very complex clinical entity that requires a "competent" caregiver to interact with the person with aphasia (PWA). The literature lacks a valid and reliable set of standardized tools which can offer objective and quantifiable data of a caregiver's communicative competence. The aim of the study was to develop, standardize and validate an evaluation tool suited to measur the caregivers' competence in communicating with family members affected by aphasic disorders. Forty-two patients with aphasia and their respective caregivers were enrolled in the study. Caregivers' communicative competence was assessed through a new evaluation tool called ACCA-cl. Aphasia severity and functional communication abilities of the PWA were also investigated. Our data showed encouraging results regarding the reliability and the validity of the ACCA-cl scale in detecting the caregiver's communicative competence, especially as far as verbal content was considered. This scale can also be used to assess the improvement achieved by the caregiver after a communication training. The analysis provides encouraging findings for verbal content scales of the ACCA-cl and its possible use in clinical settings as a quantitative tool for detecting changes induced by the educational method of the caregiver. The tool is currently available in Italian.

For half a century, Dr. Audrey Holland investigated, developed, and implemented ways to extend the assessment of adult language and cognitive-communication disorders beyond traditional impairment-based approaches. This article summarizes Dr. Holland's many groundbreaking contributions to assessment practices by describing and exemplifying major conceptual and measurement innovations that have emerged from her research of both formal and informal assessment techniques. Dr. Holland's assessment contributions encompass the development of many widely used measures of functional communication, discourse, and cognitive-communication abilities. She also contributed to the development of assessment principles that have become part of best-practice standards of care. Some of her most significant contributions include: Drawing attention to assessment within authentic functional contexts; highlighting connections between language, communication, related cognitive abilities, and broader aspects of health including quality of life; raising psychometric standards; and emphasizing the value of implementing multiple person-centered measurement techniques spanning formal and informal as well as quantitative and qualitative approaches. Dr. Holland's career-long commitment and contributions to developing more meaningful and authentic assessment practices have transformed our field and substantively elevated the quality of care and services that we are able to provide to all persons who are impacted by language and cognitive-communication disorders., Competing Interests: The author(s) declare the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The first author of this manuscript coauthored (with Audrey Holland) one of the tests described in this manuscript and receives a royalty associated with sales of this test. We are not aware of any other conflicts of interest and/or financial interests associated with this research., (Thieme. All rights reserved.)

Background: Large Vessel Occlusion (LVO) screening tools provide objective assessments to guide diagnostic decisions during acute stroke activations. The Stroke VAN screening tool includes weakness, vision, aphasia, and neglect; however, only screens positive if weakness is present regardless of presence of other symptoms including isolated aphasia. The purpose of this project was to evaluate wAve, a modified Stroke VAN screening tool. WAve includes components of VAN with emphasis on isolated aphasia., Methods: We conducted a retrospective cohort study on 376 persons who presented with stroke symptoms within 24 h of last known well (LKW) to the Emergency Department of an urban comprehensive stroke center in north central Texas between July 2019 and January 2020. Comparison of VAN and wAve predictive values was calculated using Chi square analysis. Sensitivity and specificity was checked by using MedCalc software. Data from the electronic medical record was obtained for analysis including a documented wAve score and a calculated VAN score. Results of CT angiogram diagnostic testing was used to determine congruence of screening results with evidence of LVO. Power analysis described by Hajian- Tilaki was used to estimate study size., Results: Results included 192 positive wAve screens and 184 negative wAve screens compared to 152 positive VAN screens and 224 negative VAN screens. The sensitivities for wAve and VAN were 89 % and 80 % respectively. Negative predictive values for wAve and VAN were 97 % and 95 % respectively. In isolated aphasic person, one of eight presented with a LVO and received intervention., Conclusion: The team discovered more LVOs were identified with wAve than VAN in persons exhibiting isolated aphasia symptoms. Larger studies are needed to understand the role isolated aphasia plays in LVO detection., Competing Interests: Declaration of competing interest We declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Core lexicon (CL) analysis is a time efficient and possibly reliable measure that captures discourse production abilities. For people with aphasia, CL scores have demonstrated correlations with aphasia severity, as well as other discourse and linguistic measures. It was also found to be clinician-friendly and clinically sensitive enough to capture longitudinal changes in aphasia. To our knowledge, CL has never been investigated in individuals with neurologically progressive disease., Aims: As a preliminary investigation, we sought to investigate (1) whether CL scores correlate with dementia severity, (2) whether CL scores correlate with measures of discourse quality, and (3) whether CL scores correlate with other measures of lexical/semantic access., Methods & Procedures: Twelve participants with a cognitive impairment associated with dementia of the Alzheimer's type (DAT) completed several measures of language and cognitive ability, as well as provide a language sample from the wordless picture book, Picnic., Results & Conclusion: Results are informative, as they provide insight into characteristics of CL and provide support for potential use of CL in individuals with neurologically progressive disease. The results indicated that CL scores do correlate with dementia severity and several measures of language ability, indicating they may provide a useful measure of language abilities in DAT, but more research is needed., What This Paper Adds: What is already known on the subject Core lexicon (CL) analysis is an assessment measure of discourse ability, most closely related to informativeness or productivity, used in aphasiology that is easier to use and less time consuming than previous measures of informativeness, such as correct information units or type-token ratio (TTR). For people with aphasia, CL analysis correlates with aphasia severity, measures of informativeness, as well as other measures of discourse quality. It has also been shown to be faster and more reliable between scorers than other informativeness measures. What this study adds Core lexicon analysis is a new simple and online method for assessing the informativeness of a discourse sample without the need to record or transcribe the language sample. CL is receiving a lot of attention in aphasia, correlating with everything from aphasia severity to measures of productivity and lexical access, as well as measures of informativeness. Unfortunately, no one has investigated CL analysis in dementia. The study demonstrates the first evidence that CL analysis may be a useful measure for determining dementia severity and language quality in people with dementia. What are the clinical implications of this work? Core lexicon analysis may provide clinicians and researchers with an easy method for assessing the discourse of people with a cognitive impairment associated with dementia of the Alzheimer's type. This will improve initial assessment, as well as improve ongoing language assessment that may provide clues into their functional ability to communicate effectively., (© 2024 Royal College of Speech and Language Therapists.)

Purpose: A rise in strokes worldwide means that the number of people affected by aphasia is increasing. Early and accurate diagnosis of aphasia is crucial for recovery. Presently, there are no dedicated screening tests tailored for evaluating aphasia in Serbian-speaking individuals. This paper presents and describes the psychometric properties of the Serbian Aphasia Screening Test (SAST), a novel aphasia screening tool designed specifically for Serbian speakers. This initiative fills the gap in aphasia assessment tools for the Serbian population, providing a comprehensive and culturally sensitive approach to the evaluation of language disorders., Method: Data using the SAST were collected from 240 participants: 120 Serbian speakers with aphasia after stroke compared to 120 neurotypical individuals. The assessment included the following subtests: conversation, verbal automatized sequences, auditory comprehension, visual confrontation naming, responsive naming, repetition of words, repetition of sentences, oral word reading, oral sentence reading, reading comprehension, and writing. The main objectives were to ascertain the psychometric qualities of the SAST, including inter-rater reliability of scoring, test-retest reliability, reliability of the individual subtests, overall test reliability, and inter-correlations among subtests. Additionally, the study evaluated the discriminatory capability of the SAST in distinguishing between individuals with aphasia and neurotypical controls, as well as between individuals with different types of aphasia., Results: The findings revealed that the SAST has excellent inter-rater reliability, test-retest reliability, and internal consistency. There were statistically significant differences between individuals with aphasia and neurotypical controls on all SAST subtests. Furthermore, the study identified significant differences in language profiles among participants with different types of aphasia. The significant correlations between scores on the SAST and on the Boston Diagnostic Aphasia Examination (BDAE) suggest good convergent validity of the SAST., Conclusions: The results underscore the robust psychometric properties of this novel screening assessment (SAST) and its ability to effectively discriminate between diverse linguistic abilities within different aphasia syndromes in Serbian speaking individuals., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Vuković et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The current study aimed to validate the Cantonese version of the Amsterdam-Nijmegen Everyday Language Test (CANELT), a functional communication assessment tool for Cantonese speakers with aphasia. A quantitative scoring method was adopted to examine the pragmatics and informativeness of the production of people with aphasia (PWA)., Method: CANELT was translated from its English version with cultural adaptations. The performance on the 20-item CANELT collected from 56 PWA and 100 neurologically healthy Cantonese-speaking controls aged 30 to 79 years was orthographically transcribed. Scoring was based on the completeness of the main concepts produced in the preamble and subsequent elaborations, defined as Opening (O) and New Information (NI). Measures examining the validity and reliability were conducted., Results: An age effect was found in neurologically healthy controls, and therefore z scores were used for subsequent comparisons between neurologically healthy controls and PWA. The test showed strong evidence for known-group validity in both O [χ2 (2) = 95.2, p < .001] and NI [χ2 (2) = 100.4, p < .001]. A moderate to strong correlation was found between CANELT and standardized aphasia assessment tools, suggesting satisfactory concurrent validity. Reliability measures were excellent in terms of internal consistency (Cronbach's α of .95 for both 'O' and 'NI'), test-retest reliability (ICC = .96; p < .001), intra-rater reliability (ICC = 1.00; p < .001), and inter-rater reliability for O (ICC = .99; p < .001) and NI (ICC = .99; p < .001). Sensitivity and specificity for O are 97% and 76.8%, respectively, while for NI, a sensitivity of 95% and specificity of 91.1% were obtained., Conclusions: Measures on validity and reliability yielded promising results, suggesting CANELT as a useful and reliable functional communication assessment for PWA. Its application in managing PWA and potential areas for development are discussed., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Winsy Wing Sze Wong. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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

Background: The use of telepractice in aphasia research and therapy is increasing in frequency. Teleassessment in aphasia has been demonstrated to be reliable. However, neuropsychological and clinical language comprehension assessments are not always readily translatable to an online environment and people with severe language comprehension or cognitive impairments have sometimes been considered to be unsuitable for teleassessment., Aim: This project aimed to produce a battery of language comprehension teleassessments at the single word, sentence and discourse level suitable for individuals with moderate-severe language comprehension impairments., Methods: Assessment development prioritised response consistency and clinical flexibility during testing. Teleassessments were delivered in PowerPoint over Zoom using screen sharing and remote control functions. The assessments were evaluated in 14 people with aphasia and 9 neurotypical control participants. Modifiable assessment templates are available here: https://osf.io/r6wfm/., Main Contributions: People with aphasia were able to engage in language comprehension teleassessment with limited carer support. Only one assessment could not be completed for technical reasons. Statistical analysis revealed above chance performance in 141/151 completed assessments., Conclusions: People with aphasia, including people with moderate-severe comprehension impairments, are able to engage with teleassessment. Successful teleassessment can be supported by retaining clinical flexibility and maintaining consistent task demands., What This Paper Adds: What is already known on the subject Teleassessment for aphasia is reliable but assessment of auditory comprehension is difficult to adapt to the online environment. There has been limited evaluation of the ability of people with severe aphasia to engage in auditory comprehension teleassessment. What this paper adds to existing knowledge Auditory comprehension assessment can be adapted for videoconferencing administration while maintaining clinical flexibility to support people with severe aphasia. What are the potential or actual clinical implications of this work? Teleassessment is time and cost effective and can be designed to support inclusion of severely impaired individuals., (© 2023 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Introduction/background: DC&#95;TRAIN&#95;APHASIA is an ongoing multicenter, randomized controlled trial, conducted since November 2019 under the lead of the University Medicine Greifswald (ClinicalTrials.gov Identifier: NCT03930121). The study seeks to determine whether adjuvant transcranial direct current stimulation (tDCS) can increase the effectiveness of a 3‑week treatment with intensive speech-language therapy in chronic post-stroke aphasia., Material and Method: Until the end of 2024, a total of 130 patients are to be included in Germany. Recruitment has been a challenge throughout the study and substantial efforts went into devising innovative recruiting approaches. Standard recruitment strategies were used, such as directly approaching people with aphasia in clinical settings, inpatient and outpatient language rehabilitation facilities, and patient support and advocacy groups, alongside more innovative techniques including radio commercials, dissemination of study information via national television and social media platforms., Provisional Results: Up until now, 110 patients have been included into the study. The largest short-term response was achieved via television and radio. The largest long-term response was obtained through recruitment via logopaedic and neurological facilities, patient support groups, and social media. Participants served as "testimonials", expressing that they were satisfied with the therapy and the tDCS application., Discussion: The multicenter study DC&#95;TRAIN&#95;APHASIA aims to provide evidence on tDCS as an adjuvant application to increase the effect size of intensive speech-language therapy in chronic post-stroke aphasia. The present review may guide future studies in recruiting samples that involve people with impaired communicative abilities., (© 2023. The Author(s).)

Purpose: This study was designed to examine the hypothesis that discourse task types influence language performance in Mandarin Chinese-speaking people and to reveal the discourse task-specific linguistic properties of persons with anomic aphasia compared to neurotypical controls., Method: Language samples from persons with aphasia ( n = 31) and age- and education-matched controls ( n = 31) across four discourse tasks (sequential-picture description, single-picture description, story narrative, and procedural discourse) were collected from Mandarin AphasiaBank. Task-specific distributions of parts of speech were analyzed using mosaic plots. The main effects of tasks in each group and the between-group differences within each task for several typical linguistic variables were evaluated, including the mean length of utterance, tokens, moving-average type-token ratio, words per minute, propositional density, noun-verb ratio, noun percentage, and verb percentage., Results: The results revealed an impact of discourse tasks on most language variables in both groups. In the healthy controls, story narratives yielded the highest total words and lowest verb percentage. In the aphasia group, procedural discourse elicited the fewest total words and densest expressions, whereas their single-picture descriptions had the highest noun-verb ratio. For all tasks, the aphasia group performed worse than the control group in the mean length of utterance, tokens, moving-average type-token ratio, and words per minute. For noun-verb ratio, noun percentage, and verb percentage, only one task (i.e., single-picture description) showed significant between-group differences., Conclusion: The selection of discourse tasks should be addressed in assessments and interventions for Mandarin Chinese-speaking individuals with aphasia to obtain more accurate and feasible outcomes.

Purpose: The purpose of this study was to examine the cognitive functions of Mandarin speakers with poststroke aphasia and to investigate the relationship between nonlinguistic cognitive deficits and the severity of aphasia., Method: Twenty-three adults with aphasia resulting from left-hemispheric stroke and 23 adults matched for age and educational level completed a series of six nonlinguistic cognitive tests measuring nonverbal intelligence, short-term memory, visual selective attention, visual alternating attention, auditory selective attention, and auditory alternating attention. A standardized aphasia assessment (Concise Chinese Aphasia Test [CCAT]) was also conducted to evaluate the severity of aphasia. Data analyses examined cognitive functions by comparing task performance of the two groups and examining the relationship between scores on the cognitive tasks and aphasia severity based on a hierarchical regression analysis., Results: The aphasia group scored significantly lower than the control group on all nonlinguistic cognitive tasks with large effect sizes ( d = 0.95 ~ 1.54). Significant associations between different nonlinguistic cognitive tasks and CCAT subtests were observed. Results from the hierarchical regression analysis showed that auditory alternating attention was the only factor that significantly predicted aphasia severity based on CCAT overall scores after age and education level were taken into account., Conclusions: The findings align with prior research observing deficits in nonlinguistic cognition in individuals with aphasia. Implications for clinical practice and future research are discussed.

Purpose: This study aimed to explore how well persons with anomic aphasia communicate information during discourse regarding quantity, quality, and efficiency compared to neurotypical controls, to investigate the influence of discourse tasks on informativeness and efficiency and to examine impact factors like aphasia severity and cognitive ability., Method: Language samples of four discourse tasks from 31 persons with anomic aphasia and 31 neurotypical controls were collected from Mandarin AphasiaBank. Correct information unit (CIU) analysis measures including the total number of CIUs, percentage of CIUs, CIUs per minute, and words per minute were calculated. Group differences and the effects of discourse tasks on informativeness and efficiency were investigated. Correlations of CIU analysis measures with aphasia severity and cognitive ability were examined., Results: Persons with anomic aphasia showed lower efficiency in conveying information than controls. They underperformed controls on all CIU analysis measures when executing story narrative tasks. Discourse tasks influenced the informativeness and efficiency of both groups. Neurotypical controls delivered the greatest quantity of information most efficiently when narrating stories. Persons with anomic aphasia exhibited reduced quantity of information during procedural discourse and displayed superior information quality in sequential-picture descriptions. Discourse information may be impacted by aphasia severity and cognitive ability, with varying effects depending on the task., Conclusions: Persons with anomic aphasia are inefficient in communicating discourse messages and perform poorly on all measures in story narratives. When measuring discourse information, the effects of discourse tasks and factors like aphasia severity and cognitive ability should be considered.

Objective: To analyse and discuss the association of gender differences with the risk and incidence of poststroke aphasia (PSA) and its types, and to provide evidence-based guidance for the prevention and treatment of poststroke aphasia in clinical practice., Data Sources: Embase, PubMed, Cochrane Library and Web of Science were searched from January 1, 2002, to December 1, 2023., Study Selection: Including the total number of strokes, aphasia, the number of different sexes or the number of PSA corresponding to different sex., Data Extraction: Studies with missing data, aphasia caused by nonstroke and noncompliance with the requirements of literature types were excluded., Data Synthesis: 36 papers were included, from 19 countries. The analysis of 168,259 patients with stroke and 31,058 patients with PSA showed that the risk of PSA was 1.23 times higher in female than in male (OR = 1.23, 95% CI = 1.19-1.29, P < 0.001), with a prevalence of PSA of 31% in men and 36% in women, and an overall prevalence of 34% (P < 0.001). Analysis of the risk of the different types of aphasia in 1,048 patients with PSA showed a high risk in females for global, broca and Wenicke aphasia, and a high risk in males for anomic, conductive and transcortical aphasia, which was not statistically significant by meta-analysis. The incidence of global aphasia (males vs. females, 29% vs. 32%) and broca aphasia (17% vs 19%) were higher in females, and anomic aphasia (19% vs 14%) was higher in males, which was statistically significant (P < 0.05)., Conclusions: There are gender differences in the incidence and types of PSA. The risk of PSA in female is higher than that in male., (© 2024. The Author(s).)

Introduction: Aphasia and neglect in combination with hemiparesis are reliable indicators of large anterior vessel occlusion (LAVO). Prehospital identification of these symptoms is generally considered difficult by emergency medical service (EMS) personnel. Therefore, we evaluated the simple non-paretic-hand-to-opposite-ear (NPE) test to identify aphasia and neglect with a single test. As the NPE test includes a test for arm paresis, we also evaluated the diagnostic ability of the NPE test to detect LAVO in patients with suspected stroke., Methods: In this prospective observational study, we performed the NPE test in 1042 patients with suspected acute stroke between May 2021 and May 2022. We analyzed the correlation between the NPE test and the aphasia/neglect items of the National Institutes of Health Stroke Scale. Additionally, the predictive values of the NPE test for LAVO detection were calculated., Results: The NPE test showed a strong, significant correlation with both aphasia and neglect. A positive NPE test result predicted LAVO with a sensitivity of 0.70, a specificity of 0.88, and an accuracy of 0.85. Logistic regression analysis showed an odds ratio of 16.14 (95% confidence interval 10.82-24.44) for predicting LAVO., Conclusion: The NPE test is a simple test for the detection of both aphasia and neglect. With its predictive values for LAVO detection being comparable to the results of LAVO scores in the prehospital setting, this simple test might be a promising test for prehospital LAVO detection by EMS personnel. Further prospective prehospital validation is needed., (© 2024 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Competing Interests: The authors report no conflicts of interest.

Background People with aphasia experience depression and anxiety associated with negative outcomes across a range of time post-stroke. Stroke clinicians are well-positioned to facilitate low-intensity psychotherapeutic interventions after aphasia (e.g. mood screening, behavioural activation, problem-solving therapy, relaxation therapy); however, they self-report a lack of knowledge, skills and confidence to do so. The Theoretical Domains Framework (TDF) provides a lens through which to view and target clinician behaviours and training needs in this area of practice. The aim of this study was to develop and gain consensus on items for a rating scale of clinical competencies in facilitating individual-based, low-intensity psychotherapeutic interventions for people with aphasia. Methods An e-Delphi methodology using focus groups and survey rounds was used to gain consensus on clinical competencies considered important. Results Eight stroke clinicians (speech pathologists and psychologists), two people with aphasia and three family members participated in one of four focus groups. Four themes were derived from the data: (1) Communication support, (2) Assessment and therapy structure, (3) Interpersonal skills, and (4) Needs of the significant other (family or friend). Themes informed an initial list of 23 self-rated and observer-rated competency items. Following two rounds of e-Delphi surveys, 11 stroke clinicians (six speech pathologists and five psychologists) reached consensus (80-100%) for 19 competencies. Conclusions The Psychological Care in Aphasia Rehabilitation Competency scale offers a preliminary list of items to guide and train clinicians to implement low-intensity psychotherapeutic interventions for people with aphasia.

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

Purpose: Participation in aphasia groups is associated with increased communication, reduced feelings of social isolation, and increased quality of life. Despite the growing popularity of online aphasia groups, little is known about how to manage conversation in this format. We examined online aphasia book club sessions to examine how the facilitator supported group members' participation in conversation., Method: Interactional sociolinguistic discourse analysis was used to analyze the behaviors and actions of the facilitator and group members. Qualitative data for this study were drawn from four recorded online aphasia book club sessions held through a university's free aphasia clinic on the Zoom web-conferencing platform., Results: Sociolinguistic discourse analysis revealed strategic facilitator behaviors that served to (a) give members with varying levels of verbal language abilities voice, (b) foreground or background aspects of voice, and (c) minimize her own voice to promote interactional symmetry between herself and group members., Conclusions: Identity formed the backdrop for facilitators' actions when leading online groups, guiding decisions about who got to talk, when, for how long, through what modality, and about what topics. A better understanding of the interactions that occur online, such as how to develop and protect the identities of group members, could equip facilitators with the tools necessary for facilitating positive, engaging aphasia therapy groups online.

Purpose: The study improves our understanding of the reading comprehension difficulties seen in people with aphasia. It investigates the influence of reader characteristics, including personal demographic variables, and linguistic and wider cognitive skills, on text comprehension., Method: Seventy-five people with aphasia and 87 neurologically typical readers completed a test of paragraph comprehension. People with aphasia also completed background tests of language, attention, recognition memory, and executive functions. The influence of demographic variables (age, gender, and level of education) was analyzed separately in the group of people with aphasia and the typical readers using analyses of variance. In the people with aphasia, the relationship between paragraph comprehension and the language and cognitive tests was explored using correlational analyses., Results: In the typical readers, there was a significant effect of gender and level of education and a significant three-way interaction. For the people with aphasia, there were no significant effects of demographic variables. Significant positive correlations were found between performance on paragraph comprehension and each of the language tests and with tests of auditory attention, executive functions, and recognition memory for words., Conclusions: In people with aphasia, the effects of demographic variables were overshadowed by the effect of their language difficulties. The association seen across language measures reflects the shared semantic representations across single-word, sentence, and text levels, across modalities. The study emphasizes the importance of attention, executive functions, and short-term memory in the comprehension of and memory for what we read. The contribution of both language difficulties and wider cognitive skills needs to be considered when planning intervention., Supplemental Material: https://doi.org/10.23641/asha.24695451.

Purpose: Generalization has been defined and instantiated in a variety of ways over the last half-century, and this lack of consistency has created challenges for speech-language pathologists to plan for, implement, and measure generalization in aphasia treatment protocols. This tutorial provides an overview of generalization with a focus on how it relates to aphasia intervention, including a synthesis of existing principles of generalization and examples of how these can be embedded in approaches to aphasia treatment in clinical and research settings., Method: Three articles collectively listing 20 principles of generalization formed the foundation for this tutorial. The seminal work of Stokes and Baer (1977) focused attention on generalization in behavioral change following treatment. Two aphasia-specific resources identified principles of generalization in relation to aphasia treatment (Coppens & Patterson, 2018; Thompson, 1989). A selective literature review was conducted to identify evidence-based examples of each of these 20 principles from the extant literature., Results: Five principles of generalization were synthesized from the original list of 20. Each principle was supported by studies drawn from the aphasia treatment literature to exemplify its application., Conclusions: Generalization is an essential aspect of meaningful aphasia intervention. Successful generalization requires the same dedication to strategic planning and outcome measurement as the direct training aspect of intervention. Although not all people with aphasia are likely to benefit equally from each of the principles reviewed herein, our synthesis provides information to consider for maximizing generalization of aphasia treatment outcomes., Supplemental Material: https://doi.org/10.23641/asha.24714399.

Purpose: Aphasia may decrease the capacity to develop and maintain friendships. The aim of this study was to better understand the perspectives of people with aphasia on why some friendship bonds remain strong and some do not. Furthermore, we wanted to explore how age and aphasia severity shape views on friendship., Method: We interviewed 27 people with aphasia about their experiences of friendship before and after the onset of aphasia. We then used framework analysis and reflexive thematic analysis to interpret the interview data., Results: From the interviews, we created four major themes concerning how friend relationships had been impacted by aphasia: (a) Not all bonds have the same chance of surviving the onset of aphasia; (b) people with aphasia's closest friends took active steps to keep relationships strong; (c) if friends knew some basic information about aphasia, bonds would stay stronger; (d) positive affective aspects of friendship play an important role in keeping bonds strong. We also noted differences in friendship experiences that appeared to be influenced by age and aphasia severity of participants., Conclusions: Interview data provided actionable ideas including focusing on friends who are likely to be responsive to help with maintaining the friendship, providing them with strategies to keep the friendship active and communication meaningful, and acknowledging the positive impact that this will have on the friend recovering from aphasia. More research is needed to develop programs that empower people with aphasia to maintain their friendships., Supplemental Material: https://doi.org/10.23641/asha.24688671.

Purpose: Images are a core component of aphasia assessment and intervention that require significant resources to produce or source. Text-to-image generation is an Artificial Intelligence (AI) technology that has recently made significant advances and could be a source of low-cost, highly customizable images. The aim of this study was to explore the potential of AI image generation for use in aphasia by examining its efficiency and cost during generation of typical images., Method: Two hundred targets (80 nouns, 80 verbs, and 40 sentences) were selected at random from existing aphasia assessments and treatment software. A widely known image generator, DALL-E 2, was given text prompts for each target. The success rate, number of prompts required, and costs were summarized across target categories (noun/verb/sentence) and compared to frequency and imageability., Results: Of 200 targets, 189 (94.5%) successfully conveyed the key concept. The process took a mean of 2.3 min per target at a cost of $0.31 in U.S. dollars each. However, there were aesthetic flaws in many successful images that could impact their utility. Noun images were generated with the highest efficiency and accuracy, followed by verbs, while sentences were more challenging, particularly those with unusual scenes. Patterns of flaws and errors in image generation are discussed., Conclusion: The ability to rapidly generate low-cost, high-quality images using AI is likely to be a major contribution to aphasia assessment and treatment going forward, particularly as advances in this technology continue.

Purpose: The problems that people with aphasia encounter when reading passages are poorly understood. This study's purpose was in-depth examination of eye-gaze behaviors exhibited by five people with aphasia-based alexia., Method: Five adults with aphasia-based alexia and five neurotypical adults (NAs) read paragraphs while having their eye movements recorded. Acquired data included descriptive characterization of overall eye-gaze behaviors and determination of the (a) percent of fixated words, (b) average fixation duration, (c) average initial and total summed fixation durations of processing attempts on individual words, and (d) effects of word length and frequency on fixation durations. Careful examination of these data allowed examination of consistencies and discrepancies among people with aphasia and supported speculation about underlying deficits., Results: Case participants exhibited unique fixation behaviors in comparison to one another and to neurotypical adults. Case participants' total reading time, percent of fixated words, average fixation duration, and average initial and total summed fixation durations on passage words exceeded those of neurotypical adults. Four of five exhibited positive word length and negative word frequency correlations with fixation durations., Conclusions: People with aphasia display eye-gaze behaviors unique to them and differing from those of NAs when reading texts. Better understanding of the connection between specific eye-gaze behaviors and problems decoding words, linking them with lexical-semantic information, and constructing meaning from written content is necessary to further progress in developing effective assessment tools and treatments.

Introduction: The quick aphasia battery (QAB), which assesses all areas of language in detail and quickly, was developed in English. It has been shown to be suitable for bedside patients. There is a need for a Turkish bedside test that allows for a comprehensive yet rapid assessment of stroke patients in terms of aphasia. The aim of this study was to create a Turkish version of QAB (QAB-TR) and to determine its validity and reliability in Turkish-speaking patients after a stroke., Materials and Methods: The study was conducted with 188 people aged 41-88 years. Of these, 37 (19.7%) had aphasia (12 chronic, 25 acute), 53 (28.2%) were acute stroke patients without aphasia, and 98 (52.1%) were healthy controls. Internal consistency and criterion validity, test-retest reliability, and inter-rater reliability of the QAB-TR were performed. The language assessment test for aphasia was used for criterion validity. For the inter-rater reliability of the test, two different speech language therapists (SLP) administered the QAB-TR. For test-retest reliability, 2 weeks later, the same SLP who filled out the QAB-TR the first time was administered the test again. To test the validity of the test, correlations between the items and subsections were determined. Receiver operating characteristic (ROC) analysis was performed to examine the sensitivity and selectivity of the QAB-TR score, and a cut-off value was determined to distinguish patients with aphasia., Results: The inter-rater Krippendorff's alpha value of the QAB-TR total was 0.6754. There was no statistically significant difference (p > .05) between the first and second QAB-TR total scores. The correlation analysis between the QAB-TR subsection scores and the total QAB-TR score (0.244-0.897) revealed statistically significant relationships. The area under the ROC curve was statistically significant and was found to be 0.853 (95% confidence interval: 0.799-0.906). The cut-off point for the QAB score to discriminate between patients with aphasia and those without aphasia was found to be 8.825, with 0.767 sensitivity and 0.765 selectivity (1-0.235)., Conclusion: All the study results show that QAB-TR has internal consistency, criterion validity, test-retest reliability, and inter-rater reliability. It can be administered in as little as 15 min and provides information about the multidimensional linguistic profiles of individuals. QAB-TR can be used for both clinical and study purposes as a language battery that allows for the measurement of the strengths and weaknesses of Turkish-speaking individuals who have suffered a stroke in basic language areas in acute and chronic periods. It can be easily administered at the bedside for individuals who have just suffered an acute stroke and can facilitate early assessment of individuals in terms of aphasia and early initiation of therapy, if necessary., (© 2023 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Semantic tasks are frequently used when examining language functions in patients with acquired disorders such as Alzheimer's disease (AD) and aphasia. Little is known about the possible covariation between different types of tasks or their factor structure in healthy adults. Additionally, few studies have examined semantic task performances in different patient groups. The aims of this data-driven study were to examine the factor structure in a wide range of semantic tasks in healthy older adults, the possible differences in factor variables between healthy controls, patients with AD and patients with stroke aphasia, as well as the clinical applicability of tasks in differentiating the two patient groups from controls. Participants included 59 healthy older adults, 13 patients with AD and 14 patients with aphasia. The results indicated a four-factor solution for the semantic task variables: (1) the Semantic association factor, (2) the Time factor, (3) the Verbal factor and (4) the Synonym factor. The Verbal factor was the only distinguishing factor between the two patient groups. Three factors reliably discriminated between the controls and the AD patients, and the Verbal factor reliably discriminated between the controls and the aphasia patients. In addition, a few single task variables showed outstanding discrimination for both patient groups. This study supports the notions of semantic tasks tapping into more than one cognitive subcomponent and a more general semantic impairment in AD than in aphasia. In clinical assessment, choosing appropriate semantic tasks is crucial in order to reliably detect the characteristics of the impairment.

Background: Word retrieval skills change across the lifespan. Permanent alterations in the form of decreased accuracy or increased response time can be a consequence of both normal ageing processes or the presence of acquired and neurodegenerative disorders (e.g., aphasia and dementia). Despite the extensive literature exploring the neuroanatomical underpinnings of word retrieval, psycholinguistic, biolinguistic and theoretical explanations, and the vast amount of evidence from primary and secondary language disorders, the best approach to consistently capture these changes is yet to be discovered., Aims: The goal of this paper is to determine which method(s) stand(s) as the most suitable candidate(s) to provide an accurate picture of word retrieval in the oral production of different groups of adult speakers, including cases of healthy ageing, preclinical Alzheimer's disease (AD), mild cognitive impairment (MCI), aphasia and dementia., Methods & Procedures: Using an integrative review of recent peer-reviewed journal articles, we provide an overview of the different behavioural methods traditionally used to measure oral naming skills in research-oriented and clinical protocols and discuss their main advantages and limitations., Main Contribution: Most existing studies are based on the results of people with diagnosed language disorders. Despite the growing interest, the reliability of the majority of the tasks to detect subtle changes associated with healthy ageing, MCI and preclinical AD are yet to be demonstrated, and the delicate balance between informativeness and efficiency (especially in terms of administration time and variable control) in experimental protocols is yet to be achieved. In this article we propose the pursuit of an integrative overarching methodology to characterize all naming deficits (from anecdotal to permanent) and all adult populations (from healthy to pathological ageing)., Conclusions & Implications: A combination of spontaneous speech data and results from structured tasks stands as the best approach to capture changes in word retrieval skills of adult speakers with and without observable deficits. This review can guide future reflections on the necessary prerequisites of purpose-oriented, sensitive and reliable protocols for the detection of incipient word retrieval problems, thus contributing to the early diagnosis and the design of personalized multicomponent treatments., What This Paper Adds: What is already known on this subject Word retrieval skills change during adulthood as a consequence of the neurological degradation associated with ageing. These changes are more dramatic in the event of acquired and neurodegenerative disorders. Numerous studies based on people with observable language disorders have addressed the multiplicity of factors involved in word retrieval and provided evidence of potential loci of impairment from a neuroanatomical, cognitive and/or (psycho-)linguistic perspective. What this paper adds to existing knowledge This study focuses on methodological strategies to assess naming skills and provides a reflection on generally accepted good practices and unresolved challenges to inform task selection, emphasizing the necessity for a combination of methods to best capture the actual problems and needs of people confronting word retrieval difficulties in their daily lives. Task selection, variable control and administration time stand as key concepts to adjust to the requirements of research and clinical contexts. What are the potential or actual clinical implications of this work? The results of this review can orient future research towards the creation of sensitive, reliable and (ecologically) valid materials for the (early) detection of word retrieval deficits and for the customization of treatment protocols to alleviate or palliate their effects., (© 2022 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Purpose: Individuals with non-traumatic subarachnoid haemorrhage (SAH) are often excluded from studies of stroke populations due to differing pathophysiology and treatment pathways. Thus, aphasia presentation in the non-traumatic SAH population is potentially under-represented within existing research evidence., Materials and Methods: Five databases were systematically searched with terms related to "aphasia" and "subarachnoid haemorrhage." Studies were included if aphasia was attributed to non-traumatic SAH or its associated complications, and where at least one language assessment measure used determined the presence or absence of aphasia. Study quality was evaluated using the Mixed Methods Appraisal Tool (MMAT)., Results: Following deduplication, 2726 articles were identified for title and abstract screening. Full text screening for 162 articles occurred, with 18 articles selected for inclusion. Aphasia incidence ranged from 5 to 24%, and was influenced by assessment measure, timing of assessment, subgroup studied, and classifications of aphasia. Many studies excluded participants with poorer clinical outcome, intracerebral complications, or severe aphasia. Few studies used comprehensive language assessment measures to examine across language domains., Conclusions: Aphasia presentation is highly heterogenous following non-traumatic SAH. Future research using comprehensive language assessments at multiple time points post onset is required to better understand aphasia presentation and management needs for this population.

Aphasia is a systemic disorder of formed speech that develops as a result of local brain lesions. Most aphasias are characterized by damage to secondary cortical fields, which in turn are responsible for the performance of the functions of gnosis and praxis, which explains the variability in the manifestations of speech disorders in patients with acute cerebrovascular accidents. However, it is necessary in each case to diagnose the central pathological mechanism, which underlies the development of the entire syndrome and determines the entire clinical picture. The most important task of a speech therapist-aphasiologist is to qualify the defect, namely to isolate the mechanism and analyze the syndrome in order to select individual methods of corrective restoration. This article presents a case of a patient with an ischemic stroke in the left posterior cerebral artery with the development of amnestic aphasia in combination with alexia without agraphia.

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

Background: Patients with anomic aphasia experience difficulties in narrative processing. General discourse measures are time consuming and require necessary skills. Core lexicon analysis has been proposed as an effort-saving approach but has not been developed in Mandarin discourse., Aims: This exploratory study was aimed (1) to apply core lexicon analysis in Mandarin patients with anomic aphasia at the discourse level and (2) to verify the problems with core words among people with anomic aphasia., Methods & Procedure: The core nouns and verbs were extracted from narrative language samples from 88 healthy participants. The production of core words for 12 anomic aphasia and 12 age- and education-matched controls were then calculated and compared. The correlation between the percentages and the Aphasia Quotients of the revised Western Aphasia Battery was analyzed as well., Outcomes & Results: The core nouns and verbs were successfully extracted. Patients with anomic aphasia produced fewer core words than healthy people, and the percentages differed significantly in different tasks as well as word classes. There was no correlation between the core lexicon use and the severity of aphasia in patients with anomic aphasia., Conclusions & Implications: Core lexicon analysis may potentially serve as a clinician-friendly manner of quantifying core words produced at the discourse level in Mandarin patients with anomic aphasia., What This Paper Adds: What is already known on the subject Discourse analyses in aphasia assessment and treatment have increasingly garnered attention. Core lexicon analysis based on English AphasiaBank has been reported in recent years. It is correlated with microlinguistic and macrolinguistic measures in aphasia narratives. Nevertheless, the application based on Mandarin AphasiaBank is still under development in healthy individuals and patients with anomic aphasia. What this paper adds to existing knowledge A Mandarin core lexicon set was developed for different tasks. The feasibility of core lexicon analysis to evaluate the corpus of patients with anomic aphasia was preliminarily discussed and the speech performance of patients and healthy people was then compared to provide a reference for the evaluation and treatment of clinical aphasia corpus. What are the potential or actual clinical implications of this work? The purpose of this exploratory study was to consider the potential use of core lexicon analysis to evaluate core word production in narrative discourse. Moreover, normative and aphasia data were provided for comparison to develop clinical use for Mandarin patients with anomic aphasia., (© 2023 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Purpose: Conversation analysis (CA) is an established method that has been used to understand how aphasia impacts the conversational success of individuals with aphasia (IWAs) and their conversation partners. This article demonstrates CA as a valuable analytic tool for studying text messaging in aphasia to better understand the specific co-constructed actions of IWAs and their partners as they engage in this communication modality., Method: CA was applied to transcribed text message data from eight IWAs. Conversational structures present in face-to-face interactions were identified, segmented, and explicated with a focus on how IWAs and their partners negotiate interaction in this medium., Results: Three key elements of CA, namely, sequential organization, repair, and topic negotiation, were identified within the texting exchanges of participants and their texting partners and compared with existing CA studies on electronic messaging in adults without brain injury., Conclusions: Findings suggest a multitude of strategies that IWAs and their partners used to meet both transactional and interactional goals of communication. Understanding gained from applying CA to texting in aphasia can inform the development of interventions that improve access to digital communication for IWAs.

Purpose: Slow speech rate and abnormal temporal prosody are primary diagnostic criteria for differentiating between people with aphasia who do and do not have apraxia of speech. We sought to identify appropriate cutoff values for abnormal word syllable duration (WSD) in a word repetition task, interpret them relative to a data set of people with chronic aphasia, and evaluate the extent to which manually derived measures could be approximated through an automated process that relied on commercial speech recognition technology., Method: Fifty neurotypical participants produced 49 multisyllabic words during a repetition task. Audio recordings were submitted to an automated speech recognition (ASR) service (IBM Watson) to measure word duration and generate an orthographic transcription. The transcribed words were compared to a lexical database, and the number of syllables was identified. Automatic and manual measures were compared for 50% of the sample. Results were interpreted relative to WSD scores from an existing data set of 195 people with mostly chronic aphasia., Results: ASR correctly identified 83% of target words and 98% of target syllable counts. Automated word duration calculations were longer than manual measures due to imprecise cursor placement. Upon applying regression coefficients to the automated measures and examining the frequency distributions for both manual and estimated measures, a WSD of 303-316 ms was found to indicate longer-than-normal performance (corresponding to the 95th percentile). With this cutoff, 40%-45% of participants with aphasia in our comparison sample had an abnormally long WSD., Conclusions: We recommend using a rounded WSD cutoff score between 303 and 316 ms for manual measures. Future research will focus on customizing automated WSD methods to speech samples from people with aphasia, identifying target words that maximize production and measurement reliability, and developing WSD standard scores based on a large participant sample with and without aphasia.

Purpose: Little is known about the factors that clinicians use when selecting treatments. The purpose of this preliminary study was to explore a possible factor, available treatment time, in the aphasia treatment selection process., Method: A case-based vignette survey was created using de-identified assessment data from the AphasiaBank database. Six vignettes varied by aphasia type and severity and were presented under two different treatment time alternatives: 7.5 or 60 hr. Respondents were asked to select the single treatment that they would "almost certainly use" under each treatment time scenario. Treatment options were obtained from the American Speech-Language-Hearing Association Practice Portal. Respondents also answered questions about their confidence level in administering the treatments and their primary reason for selecting a particular treatment for each case scenario., Results: A total of 26 practicing speech-language pathologists with at least 5 years of clinical experience with aphasia completed the survey. A majority of respondents (76%-84%) changed the treatment they would "almost certainly use" based on a change in treatment time availability. The most frequently given reason for the overall treatment selection was that the treatment was likely to produce a functional outcome. Neither the respondents' reported confidence levels nor their years of experience were related to treatment selection., Conclusions: This is one of the first studies to investigate how clinicians select aphasia treatment. Treatment time emerged as a consistent factor in selecting aphasia treatment in this preliminary study. Recommendations for next research steps are given. We suggest that aphasia treatment research be disseminated with clear information about required treatment time., Supplemental Material: https://doi.org/10.23641/asha.23646855.

Purpose: This study aimed to (a) compare physiological arousal and attentiveness during a confrontational naming task between participants with aphasia and a control group across four conditions that varied according to emotionality of presented stimuli and (b) explore relationships among physiological arousal, attentiveness, perceived arousal, and naming performance. We hypothesized that participants with aphasia would show lower levels of arousal and attentiveness than control participants and that emotional conditions would lead to increased physiological arousal and attentiveness., Method: Eight participants with aphasia and 15 control participants completed a confrontational naming task under positive, negative, and neutral conditions and rated their perceived arousal after each. Electrophysiological recordings were taken during the entire experiment to obtain measures of heart rate (HR), HR variability, and skin conductance (SC). Videos of confrontational naming trials were rated based on visual signs of participant attentiveness during each trial., Results: Statistically significant group differences were found for HR, SC, and attentiveness ratings, but no differences were found in these measures among conditions. Correlational analyses revealed statistically significant relationships between attentiveness and response time, HR, and naming accuracy. Significant correlations were also found for HR and naming accuracy as well as perceived arousal and naming accuracy., Conclusions: Findings suggest that decreased physiological arousal or attentiveness may contribute to naming deficits for people with aphasia (PWA). Assisting PWA to fully attend to and engage in therapy tasks may be important for accurate assessment of language functions and for achieving optimal benefit in treatment.

Purpose: The goal of the Collaborative Commentary (CC) system is to make the TalkBank adult clinical databases-including AphasiaBank, DementiaBank, RHDBank, and TBIBank-open to commentary and analysis from the full community of researchers, instructors, students, and clinicians., Method: CC allows a group leader to establish a commentary group and invite colleagues or students to join as members of the group. Members can then browse through the transcript database using the TalkBank Browser. When they wish to insert a comment, they click on the utterance line number or drag the cursor across a range of utterances and a window opens to receive the comment. The comment can include open text along with codes selected from a predefined set of codes created by that commentary group., Results: CC was released for public use in August 2022. It is being used currently in five research projects and eight classes. An important feature of CC is its ability to evaluate the reliability of coding systems and to sharpen analytic categories. By familiarizing instructors and researchers with the capabilities of CC, we expect to see an increasing usage of CC for a variety of clinical and research applications., Conclusions: CC can contribute to a better understanding of connected speech features in aphasia, dementia, right hemisphere disorder, and traumatic brain injury. CC represents an extreme innovation not only for the study of adult neurogenic communication disorders but also for the study of spoken language generally.

Purpose: Conversation treatment for people with aphasia (PwA) can lead to significant changes in language impairment and quality of life. The COVID-19 pandemic has resulted in the greater use of telepractice treatment delivery. However, there is little evidence regarding the efficacy of telepractice conversation groups. This study investigated the effects of telepractice group conversation treatment on standardized measures of language function and socially oriented/patient-reported outcomes compared to in-person and no-treatment control data., Method: This study used a mixed within- and between-groups design (repeated measure/pre-post treatment), with a single-subject delayed treatment design (Shadish & Rindskopf, 2007) to establish baseline, pretreatment, and posttreatment periods for the telepractice group. Telepractice results pre- and posttreatment were compared with historical in-person and no-treatment control data obtained from a larger randomized control trial (RCT) from DeDe et al. (2019). The historical comparison data were a subset of RCT participants from the same location and included six in-person participants and seven no-treatment control group participants., Results: Results of standardized testing conducted at baseline, pretreatment, and posttreatment intervals revealed significant improvement from pre- to posttreatment on repetition and picture description tasks for the telepractice group, and significant improvement from pre- to posttreatment on the Aphasia Communication Outcome Measure, total number of relevant utterances, and percentage of complete utterances for the in-person conversation group. No significant differences were observed in the no-treatment groups., Conclusions: In contrast to the no-treatment condition, both the in-person and telepractice conditions showed the benefits of conversation group treatment. The in-person treatment condition showed improvements in a wider number of outcome measures than the telepractice condition. Overall, the results prompt further research regarding telepractice group conversation treatment for PwA.

Purpose: The purpose of this study was to determine how different background noise conditions affect the spoken language of participants with aphasia during a story retell task., Method: Participants included 11 adults with mild to moderate aphasia and 11 age- and gender-matched controls. Participants retold stories in a silent baseline and five background noise conditions (conversation, monologue, phone call, cocktail, and pink noise). Dependent measures of speech acoustics (fundamental frequency and mean intensity), speech fluency (speech rate and disfluent words), and language production (correct information units [CIUs], lexical errors, lexical diversity, and cohesive utterances) were compared between groups and across conditions., Results: Background noise resulted in higher fundamental frequency ( f o ) and increased mean intensity for control participants across all noise conditions but only across some conditions for participants with aphasia. In relation to language production, background noise interfered significantly more with communication efficiency (i.e., percent CIUs) for participants with aphasia than the control group. For participants with aphasia, the phone call condition led to decreased lexical diversity. Across groups, condition effects generally suggested more interference on speech acoustics in conditions where continuous noise was present and more interference on language in conditions that presented continuous informational noise., Conclusions: Although additional research is needed, preliminary findings suggest that background noise interferes with narrative discourse more for people with aphasia (PWA) than neurologically healthy adults. PWA may benefit from therapy that directly addresses communicating in noise., Supplemental Material: https://doi.org/10.23641/asha.23681703.

Background: Care partners of people with aphasia after stroke need various informational supports, such as aphasia education and resources for psychosocial support. However, informational support may vary across clinicians, and access to these supports remains a persistent unmet need. Using implementation science frameworks can help to assess the gap between what is known about an issue and what is occurring in practice., Aim: The aim was to identify barriers to providing informational support for care partners of people with aphasia after stroke., Method and Procedure: We performed a secondary analysis of qualitative data collected from two of our previous studies. New themes were identified by comparing feedback from both speech-language pathologists and care partners, and previously assigned codes were interpreted relative to the Knowledge to Action (KTA) framework., Outcomes and Results: We identified four implementation themes that were specifically related to the action cycle of the KTA framework: (a) Aphasia rehabilitation tends to exclude care partners, (b) aphasia rehabilitation can be hard to understand, (c) structure is lacking for care partner check-ins, and (d) care partner informational support rarely extends beyond the acute phases of recovery., Conclusion: The results suggest that changes are needed at both systemic and care provider levels to ensure that tailored information is provided to care partners of people with aphasia.

Purpose: This study aimed to investigate treatment effects of naming therapy targeting nouns and verbs in Mandarin-English bilingual adults with aphasia (BWA)., Method: Twelve Mandarin-English bilingual adults with chronic aphasia completed a 40-hr semantic-based naming treatment for either nouns or verbs. Eight of these participants completed both noun and verb treatment, and the other four completed either noun or verb treatment. Participants were trained in either Mandarin or English for both treatment cycles. Weekly naming probes were measured to capture the direct treatment gain and within- and cross-language generalizations. Performance on the standardized language assessments was analyzed to examine further generalizations beyond the word level and to standardized naming tasks., Results: Responses in the weekly naming probes showed significant treatment gains in both noun and verb treatment, but the effect was greater in verb treatment. Generalization to semantically related items was captured in noun treatment only. Cross-language generalization was identified in both noun and verb treatment with a larger effect in verb treatment. Additionally, widespread generalizations beyond the word level and to standardized naming tasks were found following both noun and verb treatment, but the effect was larger following noun treatment in discourse and verb naming tasks., Conclusions: Findings from this study suggested robust treatment effects of semantic-based naming treatment targeting nouns and verbs in Mandarin-English BWA. However, patterns of treatment gains and generalizations differed between these word categories. This study provides strong evidence of bilingual aphasia rehabilitation in Mandarin-English BWA., Supplemental Material: https://doi.org/10.23641/asha.23818299.