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Purpose: Self-efficacy and resilience are important for various aspects of rehabilitation outcome after stroke. However, little is known about how these factors are affected and related to communication outcome in stroke survivors with aphasia. The purpose was to investigate self-efficacy and resilience, and associations to language and functional communication, in people with severe post-stroke aphasia. Materials and methods: 37 participants with severe aphasia rated their self-efficacy and resilience, using adapted versions of the existing instruments DLSES and CD-RISC. In addition, linguistic ability, executive function and functional communication were assessed. Results: Participants rated their self-efficacy and resilience as expected based on reports in the literature; somewhat lower than general populations and at similar levels as clinical populations. There were no association between self-efficacy, resilience and linguistic ability. In the sample as a whole, there were no associations between self-efficacy, resilience and functional communication. However, when results were stratified by executive function, associations emerged in the group with stronger executive function. Conclusions: People with severe aphasia have decreased self-efficacy and resilience compared to general populations, but not necessarily in proportion to their language impairment. Among participants with relatively spared executive functions there were indications of an association between self-efficacy, resilience and functional communication. IMPLICATIONS FOR REHABILITATION: The constructs self-efficacy and resilience are related to several outcomes after stroke. Self-efficacy and resilience can be assessed in many people with severe aphasia, provided that materials and administration procedure are adequately adapted. There are indications of an association between functional communication and self-efficacy and resilience. Integrating activities to increase self-efficacy and resilience in aphasia rehabilitation may be beneficial to treatment outcomes regarding functional communication. [ABSTRACT FROM AUTHOR]

Using telehealth technology to deliver parent training in evidence‐based intervention has been suggested to increase the accessibility of such interventions and improve skill acquisition and generalization. Within behavior analysis, global restrictions in response to the COVID‐19 pandemic highlighted the need for the development of telehealth supports for families. The current research examined the online delivery of a parent‐mediated implementation of the Preschool Life Skills program (PLS). Four parents completed the parent PLS program with their typically developing children (aged 3–5 years) via weekly videoconferencing sessions. A multiple‐probe experimental design was employed to assess the effect of the intervention on children's preschool life skills and challenging behavior. Parental embedding of PLS strategies during daily activities was also evaluated. The results demonstrated increases in children's preschool life skills, decreases in challenging behavior, and evidence of parent acquisition and use of PLS strategies. [ABSTRACT FROM AUTHOR]

Background Aims Methods & Procedures Outcomes & Results Conclusion & Implications WHAT THIS PAPER ADDS What is already known on the subject What this study adds What are the clinical implications of this work? In the Spanish and Catalan context, there is currently a lack of standardized, linguistically adapted tools to assess people with communication disorders. This lack is especially evident when it comes to instruments designed to assess functional communication.The main objective of this study is to adapt the instrument entitled Communication Activities of Daily Living 3rd edition (CADL‐3) into European Spanish (CADL‐3VE) and Catalan (CADL‐3VC), thus providing a new tool to assess the functional communication of patients with aphasia in the Spanish and Catalan populations.A total of 152 people, all residents of Catalonia, took part in the study. The CADL‐3VE test was administered to 125 Spanish‐speaking participants, who were divided into two groups, one consisting of patients with aphasia and the other a control group. The CADL‐3VC test was administered to 27 Catalan‐speaking patients with aphasia. Other tests and assessment scales were used for the external validation of the test.Reliability scores were recorded for both new versions of the test. There was a very strong correlation between the CADL‐3VE test and external criteria. The scores for both of the new versions showed significant differences in terms of performance between the aphasia and control groups. Both versions displayed similarities with the original test with respect to most of the psychometric analyses carried out.The test makes it possible to assess everyday communicative functioning and participation in real‐world contexts. As such, it helps inform the creation of personalized, interdisciplinary treatment plans aimed at functional objectives that consider the patient's context. In order to effectively assess aphasia based on a bio‐psycho‐social perspective, it is necessary to examine functional communication. In other words, there is a need to explore the kinds of communication difficulties that people face in their everyday lives. Communication Activities of Daily Living (CADL‐3) is an English‐language test that was developed to assess functional communication by simulating certain everyday activities. This paper offers an analysis of the items, reliability and validity of the Spanish and Catalan versions of the CADL‐3 test. This new instrument has the potential to play an essential role in assessing the everyday functional communication of people with aphasia in Spain. [ABSTRACT FROM AUTHOR]

Functional communication training (FCT) provides an efficient means for reducing a variety of challenging behaviors while increasing social communication. After establishing a functional communication response (FCR), interventionists may need to design a program to thin the schedule of reinforcement to provide more durable effects and maintenance in the natural environment. Hanley et al. provided one means for thinning schedules that involved the systematic introduction of extinction (or denial trials) following a process of delaying reinforcement. This study evaluates a southeastern U.S. classroom application of this thinning process with three elementary age students who engaged in a variety of aggression, self-injury, disruption, and crying. The results indicate positive effects of the FCT program with systematic introduction of denial trials once the participants demonstrated proficiency with the FCR. In addition, data for two participants show prolonged effects post-intervention. Results are discussed in terms of extending Hanley et al. and how these procedures can be used within typical school-based settings. [ABSTRACT FROM AUTHOR]

Background: Transcranial direct current stimulation (tDCS) has emerged as a possible neuromodulatory tool to augment language therapy in post-stroke aphasia. However, there is limited information on whether tDCS may help to improve everyday functional communication. Aims: To investigate whether cerebellar tDCS combined with computerized aphasia treatment improves functional communication skills in individuals with chronic aphasia. Methods and Procedures: In a randomized, double-blind, sham-controlled, within-subject crossover study, participants received 15 sessions of anodal (n = 14) or cathodal (n = 14) cerebellar tDCS plus computerized aphasia treatment then sham plus computerized aphasia treatment, or the opposite order. Linear mixed-effects regression models were performed to evaluate (1) the effect of tDCS treatment on change in functional communication skills on the two dimensions of the American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA-FACS): Communication Independence (CI) scale and Qualitative Dimension of Communication (QDC) scale, and (2) the relationship between functional communication skills and trained and untrained naming abilities. Outcomes and Results: The results showed significant tDCS-induced gains for the overall QDC mean score, but not for the overall CI mean score. Cerebellar stimulation was more effective than sham for the overall QDC mean score immediately post-treatment, 2-weeks post-treatment and 2-months post-treatment. Follow up analysis separated by group showed that the change in the overall QDC mean score (combining both phases) were similar in participants receiving anodal or cathodal stimulation. We also found a significant linear association between the ASHA-FACS overall CI mean change scores and trained and untrained naming change scores for the tDCS condition but not sham. Conclusions: Our study provides preliminary evidence that cerebellar tDCS coupled with computerized aphasia treatment has the potential to improve the overall qualitative dimensions of functional communication skills in individuals with chronic aphasia. Clinical Trial Registration: Cerebellar Transcranial Direct Current Stimulation and Aphasia Treatment [NCT02901574] [ABSTRACT FROM AUTHOR]

Audrey Holland (1982) compared test scores to observers' ratings of conversational communicative success in people with aphasia (PWA). This springboarded a body of evidence employing observers to rate discourse. We review the utility of those ratings for assessing PWA's communication success. A traditional literature review identified 16 articles involving naive or trained raters assessing PWAs' communicative success across discourse genres. Another 10 articles reported ratings over time. Collectively, these studies evaluated 349 PWAs. Four studies utilized observers to rate the success of PWA's conversations. Eight studies that reported observers' ratings on other discourse genres found that multimodal communication and facilitative contexts improved success, and ratings of informativeness and comfort related to objective discourse analysis measures. Nine of 10 studies examining treatment effects found that communicative success ratings captured improvements. Observers' ratings provide social validity by reliably assessing the discourse-level communicative success of PWA. Ratings correlated with standardized diagnostic and objective discourse metrics but provided a window into factors that affect communicative success, including the degree to which communication is interactive, multimodal, and contextual. Integrating observers' ratings of discourse success at pretreatment may help identify supports or barriers to successful communication, facilitate individualization of treatments, and offer social validity of change. [ABSTRACT FROM AUTHOR]

This article acknowledges Audrey Holland's influence on aphasiology as it specifically relates to the emergence of a strengths-based perspective on the everyday communication of people with aphasia. We explore a historical perspective, as well as current ways in which everyday communicative events are approached in both clinical and research practice. The term "functional communication" is synonymous with Audrey's work, with linguistically-based discourse analysis and therapy both viewed as natural companions and extensions of the concept within aphasiology. Audrey's focus on the interactional side of communication and psychosocial impacts of aphasia, as well as her expertise in analysis and measurement, contributed to the coalescing of impairment-based and social communication approaches, encompassing a true sense of humanity and connectedness. Her application of these in international contexts was also noteworthy. In this article, we hope to capture principles of aphasia management that underpin current clinical practice, and also move beyond the traditional clinic context to consider aphasia groups that have had such a key role in promoting successful social communication by and with people with aphasia. We suggest future directions to further promote the principles advocated by Audrey Holland in assisting people with aphasia to move forward with confidence with their conversation partners, friends, and communities. [ABSTRACT FROM AUTHOR]

Audrey Holland was a leading innovator and speech-language pathologist (SLP) in adult neurological communication disabilities for over five decades. She was a pioneer in the involvement of SLPs with people with dementia, inspiring both knowledge development and clinical practice regarding language, functional communication, and quality of life in persons living with dementia. Dr. Holland was also an extraordinary mentor who has impacted many generations of researchers and clinicians. Here, four researchers in the area of dementia and communication discuss the lessons they learned from Dr. Holland that fundamentally shaped their careers and the field of dementia and speech-language pathology. Lessons learned include the following: (1) do not be afraid to stand out when you have a novel idea that will help people; (2) look for strengths to support functional communication; (3) use communication strategies to support identity, quality of life, and self-determination in adults with acquired communication disabilities, including those with dementia; (4) shift from pathologizing to coaching; and (5) challenge the status quo. This article concludes by discussing Dr. Holland's lasting legacy. [ABSTRACT FROM AUTHOR]

Audrey Holland's core beliefs of respect for people and the quality of their lives informed her life's work. This examination of the ways she managed the academic, research, and clinical parts of her illustrious career shows how Audrey leaves a rich legacy and serves as a model for navigating an impactful career path and enhancing clinical interactions. First, she mentored more than 30 doctoral students who then mentored further generations of students, ran clinics, or shaped policy. She also regularly taught classes, supervised student clinicians, and traveled the world doing lectures and workshops. Second, her scholarship spanned more than 50 years and a range of subjects, such as assessment and treatment, self-determination and self-advocacy, pragmatics, counseling, coaching, and communication strategies. Third, her collaborations with many colleagues within the field and in related fields extended her impact even further. Finally, a close analysis of her clinical communication style shows how Audrey's simple, nonverbal behaviors (e.g., eye contact, body position) brought out the best in the people with whom she worked. On all these levels—mentorship, scholarship, collaboration, and communication style—Audrey's legacy leaves a vast array of powerful lessons that can be studied, emulated, and appreciated for years to come. [ABSTRACT FROM AUTHOR]

Throughout her career, Audrey Holland advocated for persons with aphasia, urging clinicians and others to view each person in the context of their needs and desires in navigating daily life. In this article, we acknowledge her ideas about functional treatment, and consider their influence on contemporary, activity-focused aphasia treatment. Three criteria define activity-focused treatment: (1) activity-specific goals, (2) personally relevant targets, and (3) near-real-life practice settings. Elements of treatment design, activities, and outcome measurement described here exemplify Audrey's beliefs in person-centered clinical aphasiology. Operationalizing treatment elements and designing a context as close to real life as possible are clinical actions that support these beliefs. Activity-focused treatment and other life participation approaches have often been relegated to the last pha s e of treatment; following Audrey's example, we advocate beginning with activity-focused treatment based on a client's communication needs and desires. Activity-focused treatment benefits persons with aphasia, their families, clinicians, and other stakeholders by presenting outcomes that reflect communication change in a real-life context and that are individually relevant. Such outcomes foster an individual's inclusion in their communication environments, respect the WHO platform of functional treatment, and prepare a clinician to present outcome data relevant to that individual. [ABSTRACT FROM AUTHOR]

The Communicative Effectiveness Index (CETI) is an informant rating scale designed to measure changes in functional communication in people with aphasia (PWA) from the carer's perspective. It offers a comprehensive view of aphasia's impact on everyday communication situations, aiding clinicians in designing personalized intervention plans. The aim of this study was to translate and adapt the CETI into Greek (CETI-GR) and validate its psychometric properties. The CETI-GR was translated into Greek using back-translation. A pilot and a content validity study ensured its acceptability. The study involved 30 people with aphasia and 30 carers. The CETI-GR's psychometric properties were evaluated, including internal consistency, test–retest reliability, inter-rater reliability, and validity measures. The CETI-GR demonstrated excellent internal consistency (Cronbach's α > 0.95) and excellent inter-rater reliability (ICC ≥ 0.93). Excellent consistency was revealed when testing the CETI responses given only by PWA (α = 0.91) versus their carers (α = 0.97). Test–retest reliability was high (ICC = 0.88). Significant correlations between the CETI-GR and measures of language severity, functional communication, and quality of life supported convergent validity. The CETI-GR is a reliable tool for assessing functional communication in chronic aphasia. Its Greek adaptation enhances aphasia rehabilitation, enabling person-centered care and improving the quality of life for people with aphasia and carers. [ABSTRACT FROM AUTHOR]

Although functional communication training (FCT) usually includes extinction, withholding reinforcement is not possible or ethical with certain individuals, for some topographies of problem behavior, or in certain contexts. The current study evaluates the effects of two variations of FCT, both without extinction, on problem behavior and communication. Further, the intervention procedures were designed to evaluate participant reactivity to reinforcer parameters (e.g., magnitude, delay, and quality) in the context of the FCT variations. The parameter sensitivity assessments were effective at identifying relevant reinforcer parameters for each participant and both FCT interventions were effective in decreasing problem behavior and increasing communication for all participants. The results demonstrated that FCT was effective regardless of which reinforcer parameter was manipulated. Moreover, all sessions were conducted in participants' homes and caregivers reported high degrees of social validity for the intervention procedures and outcomes. [ABSTRACT FROM AUTHOR]

Understanding factors that influence the efficacy of functional communication training has both practical and conceptual benefits. The current study extended research in this area by exploring data from 95 consecutive applications of functional communication training with extinction across two independent clinics. We selected candidate predictor variables based on conceptual analysis, conducted preliminary exploratory analyses, and then selectively applied quantitative methods that are used in precision medicine to examine their accuracy and predictive utility. Treatment outcomes were better when challenging behavior was maintained by a single function than they were when it was maintained by multiple functions; however, these differences were most apparent among cases with an escape function. We also analyzed within‐session responding to explore the potential influence of unprogrammed establishing operations on decrements in treatment efficacy. Our within‐session measure only distinguished responders from nonresponders when escape was one of the multiple functions. Additional research is needed to validate these findings with an independent sample and to address a number of clinical conceptual issues. [ABSTRACT FROM AUTHOR]

Background Aims Methods & Procedures Outcomes & Results Conclusions & Implications WHAT THIS PAPER ADDS What is already known on the subject What this study adds What are the clinical implications of this work? PRACTITIONER POINTS Insights from the Scenario Test Issues addressed by the Scenario Test Transformation of speech‐language therapy (SLT) in Japan through the introduction of the Scenario Test‐JP The Scenario Test is recognised for its effectiveness in assessing the interactive aspects of functional communication in people with post‐stroke aphasia (PWA).To develop a Japanese version of the Scenario Test (Scenario Test‐JP) and assess its reliability and validity.Among 66 participants, we selected 61 individuals: 34 PWA and 27 healthy controls (HCs). We modified the Scenario Test‐JP based on the UK version and subsequently evaluated its reliability (internal consistency, test–retest and intra‐rater and inter‐rater reliabilities) and validity (convergent and discriminant) by comparing PWA and HCs.The Scenario Test‐JP showed strong reliability with a Cronbach's α of 0.93, test–retest reliability with an intraclass correlation coefficient (ICC) of 0.97, intra‐rater reliability with an ICC of 0.95–1.00, and inter‐rater reliability with an ICC of 0.96. The validity of the test was confirmed with concurrent scores ranging from ρ = 0.37 to 0.76 (p < 0.05) and known‐groups validity (p < 0.001, r = −0.56).The reliability and validity of the Scenario Test‐JP align with those of the original Dutch version and the UK and Greek versions. Additionally, the assessment can now include extended alternative communication methods, such as digital devices, indicating the potential of the Scenario Test‐JP for modern Japanese speech‐language therapy. Interactive communication is a facet of functional communication and is crucial for evaluating engagement and participation of people with aphasia (PWA) in speech‐language therapy. The Scenario Test provides valuable information for planning speech‐language treatment strategies by assessing dialogic communication.Interactive communication is a facet of functional communication and is crucial for evaluating engagement and participation of people with aphasia (PWA) in speech‐language therapy. The Scenario Test provides valuable information for planning speech‐language treatment strategies by assessing dialogic communication. This study describes the development of the Scenario Test‐JP for use with Japanese speakers and Japanese PWA, which is adapted from the Scenario Test UK version. This study evaluated the reliability and validity of this assessment tool and provided supporting evidence.This study describes the development of the Scenario Test‐JP for use with Japanese speakers and Japanese PWA, which is adapted from the Scenario Test UK version. This study evaluated the reliability and validity of this assessment tool and provided supporting evidence. The reliability and validity of the Scenario Test‐JP were consistent with those of the Dutch, UK and Greek versions. The Scenario Test‐JP contributes to speech‐language therapy in Japan, where high‐quality support for the activities and participation of PWA is required.The reliability and validity of the Scenario Test‐JP were consistent with those of the Dutch, UK and Greek versions. The Scenario Test‐JP contributes to speech‐language therapy in Japan, where high‐quality support for the activities and participation of PWA is required.The Scenario Test plays a crucial role in evaluating the functional communication skills of people with post‐stroke aphasia (PWA). Enhancing functional communication has been linked to improved social engagement among PWA, which in turn influences their overall quality of life (QOL).The Scenario Test aids in delineating rehabilitation objectives for activities and participation among PWA, particularly concerning functional communication. The test facilitates tailored support for PWAs’ interactive communication and forms the foundation for appropriate speech‐language therapy interventions.The integration of the Scenario Test‐JP could enhance the SLT services provided to PWA in Japan. With Japan experiencing an unprecedented ageing population, the prevalence of social isolation and diminished QOL resulting from communication disorders like stroke‐induced aphasia is expected to rise. Consequently, the SLT rehabilitation sector in Japan is actively seeking effective interventions to support functional communication among PWA. Hence, the adoption of the Scenario Test‐JP is anticipated to streamline the evaluation of functional communication, facilitating the judicious selection and timely provision of assistance to PWA in SLT, including guidance on communication partner support and communication skill training. [ABSTRACT FROM AUTHOR]

Background: There is a growing body of literature that indicates positive outcomes of group treatment approaches to intervention for communication difficulties in chronic traumatic brain injury (TBI). The published research to date examines face‐to‐face group intervention. Aim: This study draws on one of these approaches, 'Improving Natural Social Interaction: Group reHabilitation after Traumatic brain injury' (INSIGHT), and examines the adaptation of this program to a virtual setting. The principles underlying the program, which involved providing an authentic contextualised and natural environment for group interactions and enhancing opportunities for identity expression, were maintained. Methods & Procedures: Six participants with mild to severe TBI and cognitive communication difficulties participated in an 8‐week pilot program of the virtual INSIGHT program. Goal Attainment Scaling (GAS) scores completed over the course of the intervention served as the primary outcome measure. Secondary outcomes measures included The Repeatable Battery for the Assessment of Neuropsychological Status Update, The Awareness of Social Inference Test‐Revised, the La Trobe Communication Questionnaire and the Satisfaction with Life Scale. Outcomes & Results: A mixed multilevel analysis revealed significant improvement in GAS scores. A Wilcoxon signed rank test revealed no significant changes in secondary measures. Conclusions & Implications: There is a growing potential for this group treatment approach, in an online medium, and progress towards individualised goals was clear. The data have implications for examining the assessment measures typically used to document functional outcomes in clinical intervention. Future directions indicate a need to pursue more ecologically valid assessment methods. What this paper adds: What is already known on the subject: Recent literature has focused on the benefits of group intervention for cognitive communication diffuclties after traumatic brain injury (TBI). However, research to date examines only face‐to‐face group rehabilitation. As there has been a demand for a shift in the way we communicate worldwide, we must make adaptations to current intervention procedures to continue to serve individuals with diverse communication needs. What this paper adds to existing knowledge: This study contributes new information about the feasibility of a virtual communication skills group for individuals with TBI. This virtual INSIGHT (Improving Natural Social Interaction: Group ehabilitation after Traumatic brain injury) group intervention facilitates progress towards collaboratively set communication goals and the online setting has the potential to increase the accessibility of these services. What are the potential or actual clinical implications of this work?: Progress towards cognitive and social communication goals can be facilitated by an online group intervention. However, this progress was not correlated with scores on standard assessments of cognitive communication, social communication and quality of life. This has implications for the evaluation of the assessments typically used and their ecological validity and applicability to the communication context. [ABSTRACT FROM AUTHOR]

The Communicative Effectiveness Index (CETI) is an informant rating scale designed to measure changes in functional communication in people with aphasia (PWA) from the carer’s perspective. It offers a comprehensive view of aphasia’s impact on everyday communication situations, aiding clinicians in designing personalized intervention plans. The aim of this study was to translate and adapt the CETI into Greek (CETI-GR) and validate its psychometric properties. The CETI-GR was translated into Greek using back-translation. A pilot and a content validity study ensured its acceptability. The study involved 30 people with aphasia and 30 carers. The CETI-GR’s psychometric properties were evaluated, including internal consistency, test–retest reliability, inter-rater reliability, and validity measures. The CETI-GR demonstrated excellent internal consistency (Cronbach’s α > 0.95) and excellent inter-rater reliability (ICC ≥ 0.93). Excellent consistency was revealed when testing the CETI responses given only by PWA (α = 0.91) versus their carers (α = 0.97). Test–retest reliability was high (ICC = 0.88). Significant correlations between the CETI-GR and measures of language severity, functional communication, and quality of life supported convergent validity. The CETI-GR is a reliable tool for assessing functional communication in chronic aphasia. Its Greek adaptation enhances aphasia rehabilitation, enabling person-centered care and improving the quality of life for people with aphasia and carers.

Although functional communication training (FCT) usually includes extinction, withholding reinforcement is not possible or ethical with certain individuals, for some topographies of problem behavior, or in certain contexts. The current study evaluates the effects of two variations of FCT, both without extinction, on problem behavior and communication. Further, the intervention procedures were designed to evaluate participant reactivity to reinforcer parameters (e.g., magnitude, delay, and quality) in the context of the FCT variations. The parameter sensitivity assessments were effective at identifying relevant reinforcer parameters for each participant and both FCT interventions were effective in decreasing problem behavior and increasing communication for all participants. The results demonstrated that FCT was effective regardless of which reinforcer parameter was manipulated. Moreover, all sessions were conducted in participants’ homes and caregivers reported high degrees of social validity for the intervention procedures and outcomes.

This systematic review explored how virtual reality (VR) has been used to rehabilitate aphasia. Empirical studies were included where VR was used to target language, well-being, or quality of life in adults with acquired language impairment. Degenerative communication disabilities were excluded. Seven health databases were searched in October 2021. Risk of Bias was assessed using published checklists and completeness of intervention reporting evaluated. Narrative synthesis described forms of VR, rationales given, outcome measures, communication functions targeted, characteristics of interventions, and outcomes achieved within the framework of impairment, activity, and participation. Fourteen studies, involving 229 participants, met the criteria. The studies employed four forms of VR with various rationales given. Interventions used published and novel protocols. Primary outcomes targeted language impairment (12/14), activity (1/14), and well-being (1/14) and achieved positive outcomes in impairment and activity. All studies were exploratory. Risk of bias was high. Findings are discussed in the context of gains achieved by VR in other health contexts and the multi-user gaming literature. Uses of VR in aphasia rehabilitation described in the literature are limited. Most applications target the remediation of language impairments. Opportunities to address activity, participation, and wider aspects of well-being are rare. Research documenting the use of virtual reality (VR) to rehabilitate aphasia is limited and exploratory, so does not yet offer clear guidance for clinicians. Many of the identified studies have used known published protocols (e.g., naming therapy or scripts therapy) delivered through the novel VR format and focus on language impairment outcomes. VR offers clinicians a unique opportunity to address communication activity and participation through the use of multi-user virtual worlds, but this has only been explored by only two research teams. [ABSTRACT FROM AUTHOR]

The purpose of this study is to evaluate the outcomes of a remotely delivered collaborative storytelling program based on the TimeslipsTM approach in persons with aphasia (PWA). The program aims to improve social interaction, communication, and participation through a guided experience. Six PWA of mild-moderate severity and of fluent and nonfluent types participated in the program twice a week for seven weeks. They collaboratively created 28 free-form stories from staged pictures. PWA were tested pre- and post-treatment on several validated outcome measures representing each of the Living with Aphasia: Framework for Outcome Measurement (A-FROM) domains. PWA self-rated on group therapeutic factors and program satisfaction scales. To assess the benefits of the program, the results were analysed for clinical significance (reliable change index) and meaningfulness for each of the outcome measures. Comparison between pre- and post-test scores yielded clinical significance among all participants on at least one A-FROM domain and most participants improved on communication confidence, functional communication, and overall language abilities. All participants' ratings of perceived group therapeutic factors and satisfaction with the program were high. The findings provide preliminary evidence for the effectiveness of a collaborative storytelling program for PWA. Such a program may have an important place in aphasia rehabilitation in improving psychosocial and communication deficits through engagement in creative arts. Large-scale studies with rigorous mixed-methods designs are needed to build on the present findings. [ABSTRACT FROM AUTHOR]

For speakers with mild to moderate expressive aphasia the ultimate goal of aphasia therapy is to improve verbal functional communication, which may be assessed with the Amsterdam-Nijmegen Test for Everyday Language (ANELT; Blomert et al., 1995). The ANELT is based on a qualitative and transcription-less method of analysis: the scoring is based on personal judgement and directly made from the recording of the test. Previous research (Ruiter et al., 2011) has shown that a quantitative measure for the ANELT not only allows verbal effectiveness (i.e., the amount of essential information conveyed) to be measured more sensitively, but also allows derivation of a measure of verbal efficiency (i.e., average amount of essential information produced per time unit). Although the quantitative scoring further improved the construct validity of the ANELT, there is a limitation that hinders its clinical application: the quantitative measure requires orthographic transcription of the spoken responses to the test. That is, the quantitative scoring is transcription-based. In order to work towards clinical applicability of the quantitative measure of the ANELT, this study addressed the potential of a transcription-less variant of the quantitative analysis, in which the amount of essential information is directly quantified on the basis of recording, as a valid and reliable procedure for the measurement of verbal effectiveness. A total of 56 speakers of Dutch participated: 31 neurologically healthy speakers and 25 persons with aphasia. Monologic discourse elicited with 10 scenarios from an adapted version of the ANELT (Ruiter et al., 2016) was analysed with both a transcription-based quantitative method and a transcription-less quantitative one. Resulting data were systematically compared on the following psychometric properties: internal consistency, inter-rater reliability, construct validity, convergent validity, and known-group validity. Internal consistency and inter-rater reliability were good and comparable between both scoring methods. Only for one scenario did the transcription-based scoring method yield higher agreement among the raters. With respect to validity, both scoring methods seem to yield measures of the same underlying constructs, show a strong and positive correlation, and allow differentiation between persons with and without aphasia. Although future research is needed to develop norm scores and investigate other psychometric properties, the result from the comparison demonstrated the potential of the transcription-less quantitative method as a valid and reliable method to analyse monologic discourse elicited with the adapted ANELT. [ABSTRACT FROM AUTHOR]

Background: Adults with severe/profound intellectual disability typically face poor communication outcomes as they are often nonverbal and need their supporters to provide for their communication needs. This review aimed to identify studies focused on the communication resources people with severe/profound intellectual disability use for functional communication, and the enablers and barriers to functional communication. Methods: Nine databases were systematically reviewed with keywords pertaining to the functional communication of adults with severe/profound intellectual disability. Out of 3427 identified articles, 12 met the inclusion criteria. Hand searches and ancestral searches identified another 4 articles. Out of the 16 articles, two did not meet the quality assessment criteria and were excluded. Thus, 14 articles were included in this review. Results: The findings revealed that picture exchange communication systems is the most common communication system used to support the development of functional communication. The most common functions enabled by the communication systems were choice‐making and making requests. Several barriers (e.g., individual factors related to adults with severe/profound intellectual disability, others' attitudes, behaviour and knowledge) to and enablers (e.g., accessibility and availability of the communication system, training for those supporting adults with severe/profound intellectual disability) of functional communication were identified. Conclusions: Removing the barriers and enabling functional communication is essential to developing the functional communication of adults with severe/profound intellectual disability. [ABSTRACT FROM AUTHOR]

Non-linguistic cognitive deficits, which are common in people with aphasia (PWA), have been found to predict language treatment gains, particularly in naming therapy. Interventions for cognitive impairments and their potential benefits to language functioning have been explored via principles based on cognitive training and rehabilitation with mixed results. However, the effects of cognitive stimulation, which has been widely adopted in people with dementia, have not been explored in PWA. This preliminary study aimed to investigate the effects of non-linguistic cognitive stimulation on cognitive functions of PWA and/or outcomes of language treatment. It was hypothesized that cognitive stimulation utilizing non-linguistic materials might enhance the cognitive abilities of PWA, and such improvements might augment treatment gains in functional communication of PWA who received conversation therapy concurrently. Forty-seven Cantonese-speaking PWA received either conversation therapy and cognitive stimulation or conversation therapy alone. Language outcomes included the number of main concepts produced by PWA spontaneously during narration based on wordless comic strips and video-taped stories to a communication partner. A procedural description task served as the control task. Cognitive treatment outcomes were defined by two cognitive factors extracted from principal component analysis of a cognitive battery tapping attention, short-term/working memory and EF, identified as simple attention and memory (Factor 1) and executive functions (Factor 2) in a recent study (Wong & Law, 2022). Linear mixed effects (LME) modeling was carried out with cognitive and language outcomes as dependent variables while treatment condition and timepoint as fixed factors. Contrary to expectation, participants in both treatment conditions improved in cognitive and language outcomes to a similar extent immediately post-treatment. Maintenance of treatment gains in both functional communication and EF was present in both groups 8-week post treatment but not in tasks reflecting simple attention and memory. No change was observed in the language control task. Based on the preliminary findings, improvements in cognitive and linguistic performances are attributed to the meta-cognitive, explicit, goal-directed, interactive and naturalistic nature of conversation therapy. Meanwhile, the null effect of cognitive stimulation might be related to the differences in the training materials used, as well as the neuropathology of people with stroke versus people with dementia, and hence their differential responsiveness to the cognitive intervention. [ABSTRACT FROM AUTHOR]

Purpose: Stimulation approach is a therapy technique to improve language production using auditory and visual stimulation. Jellow app is a mobile app designed for compensating for impaired language skills and may be used in the intervention of persons with aphasia. The study aimed to determine the benefits of using the Jellow app as a facilitator of stimulus therapy to improve language and psychosocial domains in chronic Broca's Aphasia. Methods: Ten right-handed male adults with Broca's Aphasia were assessed on WAB and SIQOL39g tests. The control group (n = 5) was enrolled only for stimulation therapy. Pictures of objects were used for therapy with the help of auditory or auditory and visual cues. In the study group (n = 5), along with stimulus therapy, subjects were also trained on the use of icons in the Jellow app to facilitate functional communication needs. After six-months tests were readministered. Results: Post-therapy, on WAB, the improvement in spontaneous speech, repetition, and naming were found to be significantly more in the study group (4.6 ± 0.55, 4.89 ± 0.56, 5.74 ± 0.24 respectively) than the control group (2.6 ± 0.89, 3.22 ± 0.49, 3.97 ± 0.3 respectively) on 2-sample t-test. Similarly, significantly more improvement was seen in the communication domain of SAQOL39g in the study group (2.03 ± 0.17) compared to the control group (1.14 ± 0.45). Conclusion: Use of the Jellow app may be a beneficial adjunct to stimulation therapy for improving linguistic abilities and quality of life in persons with chronic Broca's aphasia. Following are the implications of this study in the rehabilitation of persons with chronic Broca's Aphasia: • Multimodality in therapy approach in traditional stimulation therapy is beneficial. • AAC Apps like the Jellow app can be used as an adjunct to the traditional stimulation approach of language intervention which facilitates the language abilities like spontaneous speech, repetition, and naming. • Language improvement due to rehabilitation is beneficial in improving the quality of life in this population. • The caregivers must be involved in the therapy program as they act as communication partners and can repeat the therapy tasks at home. • Similar type of study is warranted in a larger population so that people with chronic Broca's aphasia may get the benefit of the latest technology which may be cheaper and easier to use. [ABSTRACT FROM AUTHOR]

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The International Classification of Impairment, Disabilities and Health by the World Health Organization had a profound influence on assessing and treating people with acquired brain injuries (ABI), which cause a movement from using impairment-based intervention to use therapies that focused on improving the participation and function of the individual's daily life. Although the first step of any therapy plan is to measure the damaged function of the related dimension, no available functional communication test for Persian-speaking people with ABI is available. Our purpose of this study was to provide a Functional Communication Test for Persian-speaking patients to measure the strengths and weakness of communication in dementia-free patients with ABI. In this cross-sectional study, the first version of the Persian Functional Communication Test (P-FUCT) was designed based on the structure of the most common functional communication tests such as ASHA-FACS and CADL. The content validity ratio (CVR) were determined. The final version of P-FUCT was administered on 30 dementia-free patients with ABI completed once by a clinician and once by the caregivers and the correlation between the scores was obtained. Concurrently, the P-WAB-1 was administered to assess the concurrent validity of the P-FUCT. The results indicated that P-FUCT has an acceptable level of internal consistency (alpha = 0.96), inter-rater 0.91 and intra-rater measurements 0.95 p < 0.05 with an adequate CVR of 0.71. The correlation between P-WAB-1 and P-FUCT scores completed by clinicians and the caregivers was r = 0/79 and r = 0/80. The P-FUCT is a valid and reliable assessment tool can be use for measuring the function communication ability of dementia-free patients with ABI. [ABSTRACT FROM AUTHOR]

Aphasia is an impairment of language caused by acquired brain damage such as stroke or traumatic brain injury, that affects a person's ability to communicate effectively. The aim of rehabilitation in aphasia is to improve everyday communication, improving an individual's ability to function in their day-to-day life. For that reason, a thorough understanding of naturalistic communication and its underlying mechanisms is imperative. The field of aphasiology currently lacks an agreed, comprehensive, theoretically founded definition of communication. Instead, multiple disparate interpretations of functional communication are used. We argue that this makes it nearly impossible to validly and reliably assess a person's communicative performance, to target this behaviour through therapy, and to measure improvements post-therapy. In this article we propose a structured, theoretical approach to defining the concept of functional communication. We argue for a view of communication as "situated language use", borrowed from empirical psycholinguistic studies with non-brain damaged adults. This framework defines language use as: (1) interactive, (2) multimodal, and (3) contextual. Existing research on each component of the framework from non-brain damaged adults and people with aphasia is reviewed. The consequences of adopting this approach to assessment and therapy for aphasia rehabilitation are discussed. The aim of this article is to encourage a more systematic, comprehensive approach to the study and treatment of situated language use in aphasia. [ABSTRACT FROM AUTHOR]

New approaches in aphasia rehabilitation have recently identified the crucial role of executive functions (EFs) in language recovery, especially for people with severe aphasia (PWSA). Indeed, EFs include high-order cognitive abilities such as planning and problem solving, which enable humans to adapt to novel situations and are essential for everyday functional communication. In a randomized double-blind crossover design, twenty chronic Italian PWSA underwent ten days of transcranial direct current stimulation (tDCS) (20 min, 2 mA) over the right dorsolateral prefrontal cortex (DLPFC). Two conditions were considered, i.e., anodal and sham, while performing four types of cognitive training (alertness, selective attention, visuo-spatial working memory, and planning), all of which were related to executive functions. After anodal tDCS, a greater improvement in selective attention, visuospatial working memory and planning abilities was found compared to the sham condition; this improvement persisted one month after the intervention. Importantly, a significant improvement was also observed in functional communication, as measured through the Communication Activities of Daily Living Scale, in noun and verb naming, in auditory and written language comprehension tasks and in executive function abilities. This evidence emphasizes, for the first time, that tDCS over the right DLPFC combined with executive training enhances functional communication in severe aphasia. [ABSTRACT FROM AUTHOR]

Background: The majority of children with cerebral palsy (CP) experience challenges in functional communication from a young age. A pivotal aspect of functional communication is language comprehension. A variety of classification systems and questionnaires are available to classify and describe functional communication skills in children with CP. A better understanding of the convergent validity of (subsections of) these tools, as well as their relationship with spoken language comprehension, will be valuable in both clinical practice and research. Aims: To investigate the convergent validity of (subsections of) functional communication tools and the relationship with spoken language comprehension in children with CP. Methods & Procedures: Cross‐sectional data on 138 children were subdivided into three developmental stages based on (Dutch) educational phases: ages 18 months–3;11y (n = 59), 4;0–5;11 years (n = 37) and 6;0–8;11 years (n = 42). The following functional communication tools were used to classify and describe functional communication: Communication Function Classification System (CFCS), subscales of the Caregivers Priorities and Child Health Index of Life with Disabilities—Dutch Version (CPCHILD‐DV) and the Focus on Communication Under Six‐34 (FOCUS‐34) questionnaire. Spoken language comprehension was assessed with the Computer‐Based instrument for Low motor Language Testing (C‐BiLLT). Correlations between the functional communication tools, and with the C‐BiLLT, were calculated using Pearson's and Spearman's correlation coefficients. It was hypothesized a priori that correlations of at least 0.60 suggest good convergent validity. Outcomes & Results: At all developmental stages, a significant ordered decreasing tendency of communication outcomes was found across CFCS levels; lower CFCS levels were associated with lower scores on the CPCHILD‐DV and FOCUS‐34, and with a lower level of spoken language comprehension (C‐BiLLT). Correlation coefficients of the functional communication tools exceeded 0.60 at all developmental stages. Correlations between C‐BiLLT raw scores and the functional communication tools varied between 0.351 and 0.591 at developmental stage 18 months–3;11 years, between 0.781 and 0.897 at developmental stage 4;0–5;11 years, and between 0.635 and 0.659 at developmental stage 6;0–8;11 years. Conclusions & Implications: The functional communication tools assessed in this study showed convergent validity at all developmental stages. The CFCS, currently most widely used in paediatric rehabilitation, is adequate in the classification of functional communication. However, for more detailed clinical goal setting and evaluation of change in functional communication, the additional use of FOCUS‐34 or CPCHILD‐DV is recommended. What this paper adds: What is already known on the subject: A range of functional communication tools are available that help describe and classify functional communication in children with CP. These include the CFCS, subsections of CPCHILD‐DV and FOCUS‐34. The CFCS classifies functional communication in daily life with familiar and unfamiliar partners. Specific subsections of the CPCHILD‐DV and FOCUS‐34 include items that pertain to communicative participation. The innovative C‐BiLLT provides a standardized method to assess spoken language comprehension in children with CP and significant motor impairments. What this paper adds to existing knowledge: In the present study, convergent validity was confirmed between CFCS and specific subsections of the CPCHILD‐DV and FOCUS‐34. Correlations between these functional communication tools and the C‐BiLLT were moderate to strong. What are the potential or actual clinical implications of this work?: For clinical and research purposes (for instance, accurate prescription of augmentative and alternative communication—AAC), healthcare and educational professionals together with parents need to know how functional communication tools converge and how functional communication levels relate to the comprehension of spoken language. The CFCS provides a valid classification of functional communication abilities in children with CP. However, to measure change in functional communication and to evaluate treatment outcomes, use of additional functional communication tools such as the CPCHILD‐DV and FOCUS‐34 is recommended. When discrepancies are found between communicative abilities and spoken language comprehension, it is strongly recommended that valid tools are used in a more detailed examination of the child's spoken language comprehension skills and functional communication. [ABSTRACT FROM AUTHOR]

The research is devoted to the study of the specificity of disorders of written speech in efferent motor agraphia, depending on the functional orientation of writing. The theoretical prerequisite for the work was the functionalist approach developed in the direction of cultural-historical psychology. The goal of the study: to reveal the variability of writing disorders in efferent motor agraphia in the conditions of different types of written speech performance in terms of functional orientation. The study used ecological tasks, which were developed in the culture of everyday writing activities, and traditional diagnostic tasks aimed at assessing separate writing operations. The study involved 22 patients with post-stroke efferent motor agraphia, 13 of them were men, the average age was 55,0±8,0 years. Nineteen patients had higher education, 3 — secondary education. The results of statistical calculations did not reveal significant differences in any of the types of errors at the level of individual words. The analyzed types of written errors were revised in favor of syntactic ones. Intraindividual analysis using nonparametric criteria revealed differences in 5 types of syntax errors. The obtained differences are explained by the choice of certain writing strategies that meet the written task assigned to the patient. The analysis shows the need to take into account not only the various instrumental components of speech and structural units of the language, in particular, syntax, but also functional changes manifested at the level of pragmatics.

The literature on the systematic application of delay and denial to reinforcement is limited to specific delivery models (i.e., in‐person discrete teaching) and particular settings (i.e., highly controlled laboratory or clinical settings). The purpose of the current study is threefold: 1) to extend previous research on a functional communication and delay and denial tolerance training by teaching procedures to caregivers systematically via a telehealth service delivery model, 2) to evaluate delayed access to reinforcement in different clinical populations, and 3) to modify previously published procedures in order to increase participant exposure to evocative setting events. Parents were trained to deliver all direct assessment and intervention procedures to five children, aided by in vivo coaching by their therapists. All participants were able to meet their terminal wait criterion while achieving behavior reductions greater than 90% of baseline. Implications for continued use of telehealth as a primary means of service delivery are discussed. [ABSTRACT FROM AUTHOR]

Lipreading is one of the communication systems of people with hearing impairment. We encounter it when communicating with individuals with hearing impairments from an early age to old age, regardless of the type of hearing impairment or compensatory aid that the individual uses. The difference is in the degree of usage and understanding that results from the individual needs and capabilities of each person. Lipreading is a very demanding mental activity. Not every individual with a hea-ring impairment can lip-read or is able to learn to lip-read. However, its successful acquisition can play a major role in speech comprehension, education and everyday life.

Remote communicative contexts are part of everyday social, familial, and academic interactions for the modern child. We investigated the ability of second-graders to engage in remote discourse, and we determined which of several abilities—language, theory of mind, and temperament—predicted their success. Fifty 7-to-9-year-old monolingual English speakers with a wide range of language abilities participated in standardized testing and an expository discourse task in which they taught two adults to solve the Tower of London, one in simulated video chat and a second in a simulated phone condition. The discourse was scored for the inclusion of 15 items deemed relevant to the explanation. Children included from 27% to 87% of the items. They communicated more information via gesture than spoken word in both conditions. They included more spoken information in the phone condition than the video condition and more information overall in the phone condition. Performance was positively associated with spoken language ability. There was no relationship between performance and theory of mind, temperament, ability to solve the Tower of London, age, or sex. We conclude that 7-to-9-year-olds adjust the modality and content of their message to suit their remote partner's needs, but their success in remote discourse contexts varies greatly from individual to individual. Children with below-average language skills are at risk for functional impairments in remote communication.

New approaches in aphasia rehabilitation have recently identified the crucial role of executive functions (EFs) in language recovery, especially for people with severe aphasia (PWSA). Indeed, EFs include high-order cognitive abilities such as planning and problem solving, which enable humans to adapt to novel situations and are essential for everyday functional communication. In a randomized double-blind crossover design, twenty chronic Italian PWSA underwent ten days of transcranial direct current stimulation (tDCS) (20 min, 2 mA) over the right dorsolateral prefrontal cortex (DLPFC). Two conditions were considered, i.e., anodal and sham, while performing four types of cognitive training (alertness, selective attention, visuo-spatial working memory, and planning), all of which were related to executive functions. After anodal tDCS, a greater improvement in selective attention, visuospatial working memory and planning abilities was found compared to the sham condition; this improvement persisted one month after the intervention. Importantly, a significant improvement was also observed in functional communication, as measured through the Communication Activities of Daily Living Scale, in noun and verb naming, in auditory and written language comprehension tasks and in executive function abilities. This evidence emphasizes, for the first time, that tDCS over the right DLPFC combined with executive training enhances functional communication in severe aphasia.

PECS training for children with Autism Spectrum Disorder and Intellectual Disabilities has been extensively evaluated. In contrast, there is a dearth of literature on outcomes of PECS training for adults lacking functional communication skills. A literature search produced five empirical studies involving PECS training with 18 adults. The participants involved presented with a wider range of intellectual and physical challenges than those typically found in child-related research. Where noted, severity of diagnoses ranged from mild to profound and included participants with single, dual and triple diagnoses, the majority with dual diagnoses. Each of the studies shows results in line with child-related research. While the amount of research is limited, the outcomes of these few studies are profound in their implications for adults with a variety of intellectual disabilities and physical challenges. Implications for both children and adults are considered. [ABSTRACT FROM AUTHOR]

Statistical characteristics of narrow-band signal in the presence of modulating noise are considered, including case of determining the univariate density of signal distribution. The relationship between the characteristic function of instantaneous signal values and the probability distribution density (PDD) envelope with a uniform phase distribution law is determined. Expressions describing a PDD of instantaneous values of signal and additive noise under action of modulating noise are obtained. Cases where there is no and is functional relationship between amplitude and phase fluctuations have been analyzed. It is shown that with the law of phase distribution other than uniform at the interval , the signal is a nonstationary random function tending to stationary at increasing the depth of phase distortions. With uniform phase distribution, the signal is a stationary random function. It is shown that in case of functionally connected amplitude-phase distortions, the PDD signal is described through statistical characteristics of its envelope. [ABSTRACT FROM AUTHOR]

Per the Centers for Disease Control, approximately 31% of children with Autism Spectrum Disorder (ASD) are classified as intellectually disabled and between 25% and 50% of children with ASD do not develop functional verbal communication. This study was conducted to test the effectiveness of Visual Communication Analysis (VCA) as a method to teach communication and reduce maladaptive behaviors in non-verbal children with severe autism. VCA is the application of a well-established theory of motivation-The Self-Determination Theory. Since it is currently impossible to test the IQ of this subset of children with standard measures, changes in the number of letters typed correctly per minute was used to measure of progress. An additional measure used was the frequency of maladaptive behaviors at the beginning of the study compared to the frequency at the end of the study. Using both of these measures, individuals utilizing VCA in this study showed statistically significant improvements in communication as well as a decrease in maladaptive behaviors. In addition to demonstrating the efficacy of VCA, these results lead to the questioning of the validity of the original diagnosis of intellectual disability given to this subset of children with ASD. Results also highlight the need for continued research and application of well-established theories of motivation to the special needs population.

A practical functional assessment format was recently developed that informed a skill‐based treatment for the problem behavior of children diagnosed with autism spectrum disorder. Since its inception there have been multiple replications of the procedures; however, the comprehensive model has rarely been applied to populations with more complex comorbid disorders and severe problem behavior such as those diagnosed with anxiety or depression. We conducted the current study to systematically replicate the entire practical functional assessment and skill‐based treatment model with two participants diagnosed with multiple mental health disorders admitted to a severe behavior outpatient unit. The practical functional assessment identified reinforcers that were provided contingent on increasingly complex forms of communication. Problem behavior remained low for both participants after reinforcement was thinned by increasing a response requirement of completing difficult tasks. Furthermore, the results were socially validated by the parents and teachers and the treatment was extended to the home setting. [ABSTRACT FROM AUTHOR]

Objectives: Primary progressive aphasia (PPA) is a language led dementia characterised by progressive speech and language difficulties. Impairment focused PPA interventions that seek to remediate, alleviate or improve symptoms, dominate the research literature. Yet speech and language therapists (SLTs) report prioritising functional communication interventions (FCIs), which target engagement in an activity and participation in life situations. This systematic review investigates the research literature on FCIs for PPA to identify the key components of these interventions and their effectiveness. Method: A systematic search of databases identified 19 studies published between 1998 and 2018. Data were extracted from the articles using the Intervention Taxonomy adaptation (ITAX). Results: Results show that the two most common components of FCIs are to build on communication strategies people currently use, and to practise these strategies with a communication partner. There are variations in the interventions, such as location and dosage. All 19 studies report improvements, of which eight report statistically significant results. Forty-two different measures are used across the 19 studies. Conclusion: This study highlights that building on existing strategies and practising these with a CP, are key components of FCIs for people with PPA, yet there remains a lack of clarity around optimal dosage. Further rigorous research using a core set of outcome measures is a priority in this area. [ABSTRACT FROM AUTHOR]