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Background: Stylistic differences in language use, as described by sociolinguists, have also been shown to occur in disordered speech and language. In this article, we describe apraxia of speech, and compare stroke-induced and progressive forms of this neurogenic disorder. Method: Audio recordings were made of a client, CS, who had progressive apraxia of speech and progressive nonfluent aphasia. Information from control participants was also available, and use was made of published data from clients with stroke-induced apraxia of speech. Results: A range of results are reported, but in particular the comparative difficulty of spontaneous connected speech as compared to reading or repetition for the client with progressive apraxia of speech. This differed from the findings of those with apraxia of speech from stroke, in that connected speech was much more difficult in the progressive form of the disorder. Discussion/conclusion: We discuss the importance of obtaining a wide range of speech styles when collecting data from clients with a range of communication problems, and how – in the specific case of apraxia of speech – these style differences aid in analysis and diagnosis.

A setting which presents special challenges for interpreter- mediated communication is the speech pathology clinic, particularly when the encounter involves the assessment of aphasia. Drawing on a corpus of five interpreter-mediated assessments of aphasia in speakers of a range of languages (Cantonese, Greek, Tagalog and Vietnamese), this paper presents the findings of an interactive framing analysis of the corpus, focusing on illustrative extracts from two of the encounters. Analysis reveals that while the interpreters are frequently oriented towards issues of ‘meaning’ or ‘content’, the speech pathologists are generally oriented to issues of ‘form’. This is evident from the fact that the speech pathologists frequently question the interpreters about the ways in which the speaker’s language is abnormal. The interpreters, however, tend to respond to such questions with reference to their impressions of the person’s intended meaning. It is argued that these differences in orientation can be explained by the different professional knowledge schemata of speech pathologists and interpreters and the fundamentally ‘uninterpretable’ nature of many of the speakers’ utterances. This lack of shared understanding makes the interaction inefficient, and frequently results in a situation where the person with aphasia is put ‘on hold’. The paper concludes with a discussion of some practical implications for the conduct of interpretermediated aphasia assessments.

Community-based peer support groups for stroke survivors are common in the United Kingdom and aim to support rehabilitation. This study of 260 stroke survivors across 118 groups nationally used an online survey format, completed on average 3 months into the pandemic. Analysis of both quantitative and open-ended responses provided insights into how stroke group members maintained contact during the COVID-19 pandemic and how the group processes of shared social identity and perceived social support related to psychosocial outcomes (self-esteem, well-being and loneliness). Group members adapted to the pandemic early through telephone calls (61.6% of participants) and internet-based contact (70% of participants), although also showed a desire for greater contact with their groups. A stronger sense of shared social identity and perceptions of social support from the stroke groups were weakly associated with reductions in loneliness among members, and greater perceived social support was associated with higher self-esteem. However, having poor health and living alone were more strongly associated with more negative psychosocial outcomes. The discussion considers how barriers to contact during pandemics can be managed, including access and use of online communication, limitations imposed by stroke-related disability, and how the experience of feeling supported and social identification can be better nurtured within remote contexts.

Purpose: Aphasia has a negative impact on a person’s quality of life (QOL). The Stroke Aphasia Quality of Life-39 scale (SAQOL-39) is a widely-used measure of health-related quality of life (HRQOL) developed for people with aphasia that has been translated into several languages. Its psychometric properties have been examined not only in English, but also in other languages. This study examined the reliability and validity of a translation and adaptation of the SAQOL-39 into Serbian in Serbian-speaking people with aphasia.Method: Using forward and backward translation, the SAQOL-39 was translated and adapted from English into Serbian and its psychometric properties were examined in 90 Serbian-speaking people with a broad range of times post-onset of aphasia. Internal consistency, test–retest reliability and other analyses were conducted.Result: Internal consistency and test–retest reliability of the Serbian version was high (Cronbach’s α > 0.9; ICC ≥0.87), which is similar to versions of the scale in other languages.Conclusion: The Serbian translation and adaptation of the SAQOL-39 was shown to be a valid and reliable measure of QOL in people with aphasia with reliable psychometric properties and is suitable for the assessment of Serbian people with aphasia. acceptedVersion This is the peer‐reviewed version of the article: VukoviĆ, M.; Sukur, Ž.; VukoviĆ, I.; Salis, C.; Code, C. Reliability and Validity of the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) for a Serbian Population. International Journal of Speech-Language Pathology 2021, 0 (0), 1–5. [https://doi.org/10.1080/17549507.2021.1971298]

The aim of this paper is to develop further the idea that symptoms that emerge in speech and language processing following brain damage can make a contribution to discussions of the early evolution of language. These diverse impairments are called aphasia, and this paper proposes that the recovery of a non-fluent aphasia syndrome following stroke could provide insights into the course of the pre-history of human language evolution. The observable symptoms emerge during recovery, crucially enabled by (dis)inhibition in parallel with a range of impairments in action processing (apraxias), including apraxia of speech. They are underpinned by changes in cortical and subcortical status following brain damage. It is proposed that the observed recovery mimics ontogenic and phylogenic processes in human speech and language. The arguments put forward provide insights tending to support the motor-gestural model of speech and language evolution. This article is part of the theme issue ‘Reconstructing prehistoric languages’.

ObjectivesPilot feasibility randomised controlled trial (RCT) for the singing groups for people with aphasia (SPA) intervention to assess: (1) the acceptability and feasibility of participant recruitment, randomisation and allocation concealment; (2) retention rates; (3) variance of continuous outcome measures; (4) outcome measure completion and participant burden; (5) fidelity of intervention delivery; (6) SPA intervention costs; (7) acceptability and feasibility of trial and intervention to participants and others involved.DesignA two-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed methods process evaluation and economic evaluation.SettingThree community-based cohorts in the South-West of England.ParticipantsEligible participants with post-stroke aphasia were randomised 1:1 to SPA or control.InterventionThe manualised SPA intervention was delivered over 10 weekly singing group sessions, led by a music facilitator and assisted by an individual with post-stroke aphasia. The intervention was developed using the Information-Motivation-Behavioural skills model of behaviour change and targeted psychosocial outcomes. Control and intervention participants all received an aphasia information resource pack.Outcome measuresCollected at baseline, 3 and 6 months post-randomisation, candidate primary outcomes were measured (well-being, quality of life and social participation) as well as additional clinical outcomes. Feasibility, acceptability and process outcomes included recruitment and retention rates, and measurement burden; and trial experiences were explored in qualitative interviews.ResultsOf 87 individuals screened, 42 participants were recruited and 41 randomised (SPA=20, control=21); 36 participants (SPA=17, control=19) completed 3-month follow-up, 34 (SPA=18, control=16) completed 6-month follow-up. Recruitment and retention (83%) were acceptable for a definitive RCT, and participants did not find the study requirements burdensome. High fidelity of the intervention delivery was shown by high attendance rates and facilitator adherence to the manual, and participants found SPA acceptable. Sample size estimates for a definitive RCT and primary/secondary outcomes were identified.ConclusionsThe SPA pilot RCT fulfilled its objectives, and demonstrated that a definitive RCT of the intervention would be both feasible and acceptable.Trial registration numberNCT03076736.

Extensive study since the early 1980s began to show that language and speech can be impaired in a variety of ways by progressive neurological damage in the absence of significant impairments to oth...

Background: Surveys of awareness of aphasia have been conducted worldwide. There has been no survey of change in awareness in one place over time. A survey in Exeter, UK in 2001 found aware...

IntroductionThe singing for people with aphasia (SPA) intervention aims to improve quality of life and well-being for people with poststroke aphasia. A definitive randomised controlled trial (RCT) is required to assess the clinical and cost effectiveness of SPA. The purpose of this pilot study is to assess the feasibility of such a definitive trial and inform its design.Methods and analysisA two-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed methods process evaluation and economic evaluation. Forty-eight participants discharged from clinical speech and language therapy will be individually randomised 1:1 to SPA (10 group sessions plus a resource booklet) or control (resource booklet only). Outcome assessment at baseline, 3 and 6 months postrandomisation include: ICEpop CAPability measure for adults, Stroke and Aphasia Quality of Life, EQ-5D-5L, modified Reintegration into Normal Living Index, Communication Outcome After Stroke, Very Short Version of the Minnesota Aphasia Test, Service Receipt Inventory and Care Related Quality of Life. Feasibility, acceptability and process outcomes include recruitment and retention rates, with measurement burden and trial experiences being explored in qualitative interviews (15 participants, 2 music facilitators and 2 music champions). Analyses include: descriptive statistics, with 95% CIs where appropriate; qualitative themes; intervention fidelity from videos and session checklists; rehearsal of health economic analysis.Ethics and disseminationNHS National Research Ethics Service and the Health Research Authority confirmed approval in April 2017; recruitment commenced in June 2017. Outputs will include: pilot data to inform whether to proceed to a definitive RCT and support a funding application; finalised intervention manual for multicentre replication of SPA; presentations at conferences, public involvement events; internationally recognised peer reviewed journal publications, open access sources and media releases.Trial registration numberNCT03076736.

Background: It has been suggested that public awareness of aphasia is vital for extending services, research support, social inclusion and targeted raising of awareness. Earlier studies show that knowledge of aphasia varies across a range of variables, but is very low compared with other conditions. Aims: To report a series of surveys of public awareness of aphasia from six countries, the largest study conducted this far. Methods & Procedures: Surveys were conducted in Argentina (N = 800), Canada (N = 831), Croatia (N = 400), Greece (N = 800), Norway (N = 251) and Slovenia (N = 400) using the same methodology requesting information on age, sex and occupation, asking whether respondents had heard of aphasia and where they had heard of it. Respondents were tested on their levels of knowledge of aphasia. Outcomes & Results: Results revealed low levels of awareness of aphasia in countries surveyed with marked variability that appeared to interact with occupation, country, age and sex. We surveyed 3483 respondents (mean age = 43.16; SD = 17.68). Between 60% (Croatia) and 16% (Slovenia) said they had heard of aphasia (37.1% overall), but those with actual knowledge ranged from 13.9% (Norway) to 1.0% (Argentina). The combined mean of those with basic knowledge was 9.2%. Those who had heard of aphasia were younger; and females had higher levels of awareness. We also found associations between socio-economic status and awareness. Those working in health, social and educational spheres had the highest levels. Respondents mainly heard about aphasia through the media and work or personal contact with aphasia. Conclusions & Implications: Levels of awareness are low everywhere in absolute terms, and relative to the awareness of other conditions, with significant variability between countries, sex and socio-economic status. We examine how surveys can be utilized to plan ways to increase understanding and discuss the comparison of awareness of aphasia with other conditions.

Background Aphasia following stroke refers to impairments that affect the comprehension and expression of spoken and/or written language, and co-occurring cognitive deficits are common. In this paper we focus on short-term and working memory impairments that impact on the ability to retain and manipulate auditory–verbal information. Evidence from diverse paradigms (large group studies, case studies) report close links between short-term/working memory and language functioning in aphasia. This evidence leads to the hypothesis that treating such memory impairments would improve language functioning. This link has only recently been acknowledged in aphasia treatment but has not been embraced widely by clinicians. Aims To examine the association between language, and short-term and working memory impairments in aphasia. To describe practical ways of assessing short-term and working memory functioning that could be used in clinical practice. To discuss and critically appraise treatments of short-term and working memory reported in the literature. Methods & Procedures Taking a translational research approach, this paper provides clinicians with current evidence from the literature and practical information on how to assess and treat short-term and working memory impairments in people with aphasia. Published treatments of short-term and/or working memory in post-stroke aphasia are discussed through a narrative review. Main Contributions This paper provides the following. A theoretical rationale for adopting short-term and working memory treatments in aphasia. It highlights issues in differentially diagnosing between short-term, working memory disorders and other concomitant impairments, e.g. apraxia of speech. It describes short-term and working memory assessments with practical considerations for use with people with aphasia. It also offers a description of published treatments in terms of participants, treatments and outcomes. Finally, it critically appraises the current evidence base relating to the treatment of short-term and working memory treatments. Conclusions The links between short-term/working memory functioning and language in aphasia are generally acknowledged. These strongly indicate the need to incorporate assessment of short-term/working memory functioning for people with aphasia. While the supportive evidence for treatment is growing and appears to highlight the benefits of including short-term/working memory in aphasia treatment, the quality of the evidence in its current state is poor. However, because of the clinical needs of people with aphasia and the prevalence of short-term/working memory impairments, incorporating related treatments through practice-based evidence is advocated.

Purpose: Public awareness of aphasia has been surveyed in a number of countries revealing that it is universally low. We report results of surveys in the Balkan countries Serbia and Montenegro and compare results with data from Croatia and Slovenia. Methods: Convenience surveys of the general public were conducted in public places like shopping centers/malls and parks in Serbia (N=400) and Montenegro (N=500) using an adapted version of the public awareness of aphasia survey questionnaire. Respondents were asked whether they have heard of aphasia and tested with questions about aphasia. Information on gender, age, occupation and education was recorded. Outcomes: Twelve percent (Serbia) and 11% (Montenegro) had heard of aphasia, but just 4% (Serbia) and 3.2% (Montenegro) had a basic knowledge of aphasia. Age, gender and occupation interacted variably with awareness. Between 16% (Slovenia) and 60% (Croatia) said they had heard of aphasia (10.5% overall mean for the four countries) and basic knowledge of aphasia across the four countries ranged between 3.2 and 7%. Conclusions: Levels of awareness of aphasia in the Balkans are low and variably associated with age, gender, socio-economic and educational levels. Respondents with some knowledge of aphasia gained it through personal or professional interaction with aphasia or the media. The data provide a basis for awareness raising in Balkan countries to reduce stigmatization, improve community access and understanding. Implications for rehabilitation Awareness of aphasia is low universally, even among healthcare workers. Low public awareness of a condition, like aphasia, results in under-funded research and service provision. In order to raise public awareness of aphasia we need to know how many members of the general public know about it. Improvements in public awareness could positively affect funding, the quality of services, and the public understanding and acceptance of individuals with aphasia in the community. Improving awareness of aphasia in those who come into contact with aphasic people, like healthcare workers, could significantly improve the healthcare experience of people with aphasia and their families.

Background: Since Trousseau (1864) introduced the term aphasia to describe the communication impairments that follow brain damage, aphasia has been seen as a disorder of language. Before 1864, most...

Background: As well as difficulties in language function, many people with post stroke aphasia report problems with psychosocial health, including reduced social participation and social isolation,...

Recent research into nonfluent forms of primary progressive aphasia and progressive apraxia of speech has highlighted the importance of speech rate as a diagnostic feature. We describe detailed investigation and comparison of speech rate (latencies and utterance length in single word/nonword production and speech rate in connected speech) on a range of experimental tasks in a man with progressive speech deterioration of 10 years duration from Pick's Disease. C.S. had a progressive nonfluent aphasia (PNFA) together with progressive apraxia of speech (pAOS) with an absence of significant interlectual, phonological or semantic impairment. C.S. showed increased latencies but reduced word length compared to matched controls on single word and nonword repetition and reading, an absence of a syllabic length effect in either single word/nonword tasks or connected speech tasks. Further investigation suggested that underlying his speech production impairments were problems with speech initiation, termination and inhibition. Most impairments worsened with progression over a 12-month period. Results provide support for the view that progressive apraxia of speech presents differently to apraxia of speech following stroke and, especially at advanced stages, involves deterioration in more central and supportive cognitive processes.

L. Togher, S. McDonald, C. Code, Communication Problems Following Traumatic Brain Injury. S. McDonald, L. Togher, C. Code, The Nature of Traumatic Brain Injury: An Overview. C. Coelho, Discourse Analyses in Traumatic Brain Injury. R. Body, M. Perkins, S. McDonald, Pragmatics, Cognition and Communication. L. Tougher, L. Hand, C. Code, Exchanges of Information in the Talk of People with Traumatic Brain Injury. R. Body, M. Parker, Casting the Net Wide: The Use of Multiple Informants in the Assessment of Communication After Traumatic Brain Injury. N. Marsh, Social Skills Deficits Following Traumatic Brain Injury: Assessment and Treatment. B.E. Murdoch, D.G. Theodorus, Dysarthria Following Traumatic Brain Injury. S.B. Chapman, H.S Levin, S.L. Lawer, Communication Problems Resulting from Brain Injury in Children. P. Snow, J. Douglas, Discourse Rehabilitation Following Traumatic Brain Injury.

1. Introduction: The clinical scientist Donald B. Freed and Chris Code 2. Generalisation of personalised cueing to enhance word finding in natural settings Ericka Olsen, Donald B. Freed, and Robert C. Marshall 3. Verb and noun deficits in stroke-induced and primary progressive aphasia: The Northwestern Naming Battery Cynthia K. Thompson, Sladjana Lukic, Monique C. King, M. Marsel Mesulam, and Sandra Weintraub 4. Considering a multi-level approach to understanding maintenance of global coherence in adults with aphasia Heather Harris Wright and Gilson J. Capilouto 5. Training healthcare providers in patient-provider communication: What speech-language pathology and medical education can learn from one another Michael I. Burns, Carolyn R. Baylor, Megan A. Morris, Thomas E. McNalley, and Kathryn M. Yorkston 6. Generalisation of a novel implicit treatment for coarse coding deficit in right hemisphere brain damage: A single-participant experiment Connie A. Tompkins, Victoria L. Scharp, Kimberly M. Meigh, Margaret Lehman Blake, and Julie Wambaugh 7. Do principles of motor learning enhance retention and transfer of speech skills? A systematic review Lauren P. Bislick, Phillip C. Weir, Kristie Spencer, Diane Kendall, and Kathryn M. Yorkston 8. Apportioning time for aphasia rehabilitation Chris Code

Background: In the first issue of the first volume of Aphasiology in 1987, Robert Marshall contributed the first Clinical Forum Target Article entitled Reapportioning time for aphasia rehabilitation: A point of view (Marshall, 1987a), where he built an argument for spending more clinical time with aphasic people who would benefit better from treatment, than those less likely to. Aim: This paper aims to revisit Dr. Marshall's 1987 question, but from a different perspective, by asking whether the time that we, as societies apportion to aphasia and aphasic people matches with what we have learnt about the effectiveness of treatment for aphasia in the past 25 years. Method & Procedure: A short, unsystematic, review that examines recent evidence for the effectiveness of treatment for aphasic impairments. Results: While a wide range of evidence exists supporting the view that treatment for aphasic impairments can be effective, and that aphasia has a more devastating effect upon the lives of aphasic people and t...

This paper briefly explores the relevance of patterns of related symptoms of nonfluent aphasia arising from left inferior frontal brain damage for the evolution of speech, language and gesture. I discuss aphasic lexical speech automatisms (LSAs) and their resolution with recovery into agrammatism with apraxia of speech and draw parallels between this recovery and the early evolution of language to protospeech and protosyntax. I focus attention on the most common forms of LSAs, expletives and the pronoun + modal/aux subtype, and propose that further research into these phenomena can contribute to the debate on the evolution of speech and language.

In many parts of the world, speech-language pathologists (SLPs) are frequently called upon to assess aphasia in bilingual speakers, or in speakers of languages of which they have little or no knowledge. One of the strategies that SLPs employ in these situations is to involve an interpreter in the assessment process. Three authentic interpreter-mediated aphasia assessments were analysed for the present study, which aimed to determine the degree to which the content validity of the individual tests was compromised in the process of their administration through an interpreter. Findings reveal that content validity was frequently weakened either at the point of administration of the test or at the point at which responses were reported back by the interpreter to the SLP. Based on these findings, it is argued that the conduct of interpreter-mediated aphasia assessments needs to be fundamentally re-thought to take account of the limitations inherent in the interpreting process. To this end, this study presents a number of practical recommendations for the involvement of interpreters in aphasia assessments, with a view to making optimal use of existing assessment materials and enhancing the quality of diagnostic information to emerge from such clinical sessions.

It is a great pleasure for Aphasiology to edit and produce these proceedings of the 18th International Aphasia Rehabilitation Conference (IARC 2018), held at the University of Aveiro, Portugal, Sep...

There exist few clinical assessments for limb apraxia, a disorder of learned, purposeful action, that enable clinicians to distinguish pathological from normal variance in limb praxis performance. We describe a theoretically motivated, comprehensive assessment battery for limb apraxia and present control comparison scores for 16 older healthy normal individuals on subtests designed to distinguish the integrity of components of the praxis system.

We describe the investigation of speech automatisms in a man with progressive nonfluent aphasia and apraxias. Occurrence of the automatisms yes and right, were analysed across a range of speech tasks varying in length, propositionality, lexical and articulatory complexity, whether tasks engaged internal generation or external triggering and articulatory distortions, and while completing pantomimes/gestures. No differences were found in occurrence across most tasks but there was a significant interaction between automatism production and apraxic speech errors and during limb praxic tasks, suggesting that production of the automatism was unrelated to linguistic or lexical variables, but was related to the presence of speech apraxia coupled with disinhibition.

A case of progressive speech degeneration in a 63-year-old male is described, and the results of a series of verbal tasks are given. Three of the participant's phonological processes (loss of aspiration in fortis stops, denasalization, and addition of labials to /r/-initial words) are subjected to analysis via two currently important phonological paradigms: constraintbased Optimality Theory and articulation-based Gestural Phonology. The two approaches are contrasted, and Gestural Phonology appears to provide the most elegant account of the data, and the most psycholinguistically valid account for this participant, as it operates at the level of phonetic implementation rather than phonological organization.

This article details three examinations of communication impairment over 13 months in a man with AIDS dementia complex (ADC) and compares his performance on standardised language testing with that of two control participants. He had mild language impairments as measured on standardised tests but was severely impaired in pragmatic language skills. When compared with control participants, he was particularly impaired in the skills of topic maintenance and informational redundancy and equally impaired as matched controls with AIDS on the items of non-specific vocabulary and excessive revisions. This man's communication impairment as a result of ADC, which was characterised by poor conversation skills in the absence of frank aphasia or dysarthria, may be related to non-linguistic cognitive impairment. Learning outcomes: Readers will be able to: (i) identify and recognise a general process of central nervous system changes and symptoms in ADC; (ii) recognise and describe changes in the language and communication skills in people with dementias resulting from diffuse neuropathology including in those with ADC; (iii) consider any changes in the communicative pragmatic style of people with ADC, in the light of hypothesising their possible links with cognitive changes in the executive functions of the brain e.g. attention and short term memory.

Neuroimaging and lesion studies suggest that a network of different brain areas are involved in mental calculation processes. Indeed, little is known about the comparability of brain activation across studies because of the variety of different design parameters. The experiment reported in the present study examined response times and fMRI-BOLD activity patterns in normal volunteers for calculation tasks entailing addition, subtraction, multiplication and division tasks of different complexities from auditory stimulation. FMRI data showed activation patterns in bilateral superior frontal, adjacent to medial frontal regions, and in right precuneus as revealed by conjunction analysis. All other regional activations appeared to be operation-specific and distributed in predominantly right hemispheric frontal, parietal and central regions. It is concluded that both operation and task presentation modalities can have significant influence on the mobilization of regional neuronal networks required for mental calculation processes. Therefore, it is suggested that results from different studies should only be compared directly when analogous presentation modalities and operators were used in the applied experimental designs.

Stuttering is present in all cultures with a prevalence of around 1%. While there has been extensive brain and behavioral research into stuttering over the last 50 years, its cause remains unknown. Brain imaging research has shown anomalous activations during stuttered speech and, more recently, has identified structural anomalies in the speech language areas of the brain. A recent meta-analysis concluded that these aberrant neural activations are a consequence of stuttering rather than a cause, and that stuttering is a disorder of the initiation of speech motor plans. Expanding on this hypothesis we propose that this disorder comprises the initiation of syllables. We provide evidence that this is underpinned by a disturbance of neural function in SMA. Our syllable initiation (SI) theory has evolved from our working model, the variability or Vmodel. SI theory draws not only on brain research in stuttering but also on research into speech production deficits after brain damage. SI theory locates stuttering at the interface of speech and language and we suggest that it provides a plausible and parsimonious explanation of the cause and critical phenomena of stuttering.

Carers and health professionals who work with people with the human immunodeficiency virus (HIV) are reported to think that the communication skills of people with HIV are "odd" and a range of difficulties with communication have been identified. However, little research has examined the "pragmatic" skills of people with HIV.Five men living with AIDS were assessed on a battery of measures of componential language to exclude aphasia. Their pragmatic appropriateness as judged using the the Pragmatic Protocol was then rated by ten experienced raters from representative portions of a semi-structured interview.All cases were rated by some raters as inappropriate on: Lexical selection specificity/accuracy. 4/5 cases had problems with: fluency, turn taking quantity, turn taking interruption/overlap and vocal quality. 3/5 were scored by some raters as having problems with: intelligibility, lexical selection: cohesion, prosody, turn taking pauses, turn taking repair/revision and vocal intensity.Several pragmatic behaviours consistent with what might be expected in people with mild diffuse or subcortical brain impairment were clearly observed. Whilst the cause of their perceived pragmatic inappropriateness cannot be established, the results suggest that cognitive-communication problems might be a feature of language use in people with HIV-AIDS even when AIDS-related dementia has not been diagnosed.

Investigations of neurodegenerative disorders may reveal functional relationships in the cognitive system. C.S. was a 63-year-old right-handed man with post-mortem confirmed Pick's disease with a range of progressive impairments including non-fluent aphasia, speech, limb, oculomotor, and buccofacial apraxia, but mostly intact intelligence, perception, orientation, memory, semantics, and phonology. During progression, agrammatism in writing with impairments in syntactic comprehension emerged in parallel with an unusual graphomotor deficit in drawing and writing, with an increasing deterioration of graphic short-term memory. We investigated C.S.'s graphomotor deficit longitudinally using tests of writing and drawing on letters, words, and sentences and drawing to command and copying. We also tested C.S.'s short-term graphemic buffer experimentally. Analysis showed deficits on selective aspects of graphomotor implementation of writing and drawing, mainly affecting the production of circles and curves, but not short straight lines in drawing and writing, and graphomotor short-term memory, which paralleled impairments of written syntax and syntactic comprehension. We believe this to be the first detailed analysis of such an unusual progressive impairment in graphomotor production, which may be related to problems with agrammatic agraphia and impairments affecting shared components of cognition reflecting damage to shared neural networks. Alternatively, they may simply reflect the effects of coincidental damage to separate mechanisms responsible for aspects of writing, drawing, and syntactic processing. Longitudinal investigations of emerging deficits in progressive conditions like C.S.'s provides an opportunity to examine the progressive emergence of symptoms in an individual with multiple progressive impairments as they appear and examine putative relationships between them.

Despite the relatively high prevalence of aphasia, research indicates that, world-wide, public awareness of aphasia is lacking. Of the surveys that have been conducted internationally, none has studied the Canadian public's awareness of aphasia. The purpose of the present survey was to assess public awareness and basic knowledge of aphasia of individuals in southern Ontario, Canada.Using the same questionnaire that has been used in other countries, face-to-face surveys were conducted in public places (e.g. parks) at various locations in southern Ontario. Respondents were asked questions pertaining to their awareness and knowledge of aphasia. The number of surveys retained for analysis was 831. In addition to an evaluation of public awareness and knowledge of aphasia, the potential influences of age, gender, and occupation were analysed. For those who had heard of aphasia, questions were asked to determine how or where they had heard of aphasia.Consistent with the literature, overall public awareness and basic knowledge of aphasia in southern Ontario was found to be limited. The factors of age, gender and occupation were found to influence the results.This investigation supports the need for better promotion of aphasia awareness to the public in southern Ontario and, by extension, in Canada.

We welcome the lead article (Rose, ) and congratulate Miranda Rose for raising important issues for the utility of gesture and pantomime in the rehabilitation of people with aphasia. We take this opportunity to briefly discuss recent theoretical developments and experimental research in the cognitive neurosciences on the relationships between language and action. We comment briefly on some issues raised in the review, including the question of how it is that some people with aphasia are able to utilise gesture and others are not, the relationship between propositional and spontaneous gesture and the degree to which treatment utilising gesture is possible at all for people with severe limb apraxia. Research based on experimental and theoretical developments forms the promising basis for further investigations into the utility of gesture as a facilitator for language in aphasia. We wonder, however, if it is those most in need of gesture and pantomime to compensate for severe impairment who are the least lik...

Current work in the evolution of language and communication is emphasising a close relationship between the evolution of speech, language and gestural action. This paper briefly explores some evolutionary implications of a range of closely related impairments of speech, language and gesture arising from left frontal brain lesions. I discuss aphasic lexical speech automatisms (LSAs) and their resolution with some recovery into agrammatism with apraxia of speech, an impairment of speech planning and programming. I focus attention on the most common forms of LSAs, expletives and the pronoun+modal/aux subtype, and propose that further research into these phenomena can contribute to the debate. I briefly discuss recent studies of progressively degenerating neurological conditions resulting in progressive patterns of cognitive impairments that promises to provide insight into the evolutionary relationships between speech, language and gesture.

Background: Communication disorders after traumatic brain injury (TBI) are difficult to modify due to the cognitive limitation imposed by frontal lobe damage. As an alternative approach, this paper describes a training programme designed to improve communication partners' responsiveness to people with TBI during routine service inquiries with a community agency. Aims: To evaluate the effectiveness of a training programme aimed at improving the communication of police officers during service encounters with people with TBI. Methods & Procedures: A total of 20 police officers were randomly assigned to two groups (training or control). Prior to the 6‐week training programme, participants with TBI made a routine telephone inquiry to the police officers. Training focused on specific aspects of telephone inquiries previously documented to be aberrant in service encounters of people with TBI. Following the training programme, police subjects received another telephone service inquiry. Service encounters were tra...

One of the symptoms of Global or severe Broca's aphasia is a type of speech automatism. Speech automatisms are involuntary, stereotyped and repetitive utterances which can be produced either as lexical or non-lexical forms. Previous research has examined the different types of lexical and non-lexical utterances produced by German and British aphasic speakers. The lexical utterances are mostly composed of high frequency words, emotional expressions, interjections and proper names while non-lexical utterances, also called recurring utterances, are made up of, concatenated and reiterated consonant and vowel syllables which do not form recognisable words. The purpose of this study was to investigate relationships between lexical and non-lexical speech automatisms obtained in German and British aphasic speakers with those found in Cantonese aphasic speakers. Cantonese is a tonal Chinese dialect which employs the use of six lexical tones and is used mainly in the southern part of China, Hong Kong and Macau. Twe...

Background: In order for readers to fully understand the results of published studies of aphasia, and in order to replicate studies and conduct meta‐analyses, it is critical that authors adequately describe the participants in these studies. A number of authors have made recommendations as to which variables should be included in descriptions of participants in studies of aphasia. In addition, the American Psychological Association (APA) publication manual (2001)—the most widely recognised standard for the social sciences—includes specific guidelines for describing research participants. Aims: To review how aphasic participants in current studies are described, and to assess the adequacy of these descriptions in relation to both the APA guidelines (2001), and the recommendations made by Brookshire (1983). Methods & Procedures: We reviewed 100 articles on aphasia, published in 2001 and 2002, and identified which of 43 variables were included in the descriptions of participants. The audit included only arti...

The last decade in particular has seen a broad acceptance across many fields that a person's social relationships and community activity impact significantly on their well-being and also on their g...