Tau-U: A Quantitative Approach for Analysis of Single-Case Experimental Data in Aphasia

Purpose

Tau-U is a quantitative approach for analyzing single-case experimental design (SCED) data. It combines nonoverlap between phases with intervention phase trend and can correct for a baseline trend (Parker, Vannest, & Davis, 2011). We demonstrate the utility of Tau-U by comparing it with the standardized mean difference approach (Busk & Serlin, 1992) that is widely reported within the aphasia SCED literature.

Method

Repeated writing measures from 3 participants with chronic aphasia who received computer-based writing treatment are analyzed visually and quantitatively using both Tau-U and the standardized mean difference approach.

Results

Visual analysis alone was insufficient for determining an effect between the intervention and writing improvement. The standardized mean difference yielded effect sizes ranging from 4.18 to 26.72 for trained items and 1.25 to 3.20 for untrained items. Tau-U yielded significant (p < .05) effect sizes for 2 of 3 participants for trained probes and 1 of 3 participants for untrained probes. A baseline trend correction was applied to data from 2 of 3 participants.

Conclusions

Tau-U has the unique advantage of allowing for the correction of an undesirable baseline trend. Although further study is needed, Tau-U shows promise as a quantitative approach to augment visual analysis of SCED data in aphasia.

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Considerations for the Use of Neuroimaging Technologies for Predicting Recovery of Speech and Language in Aphasia

Purpose

The number of research articles aimed at identifying neuroimaging biomarkers for predicting recovery from aphasia continues to grow. Although the clinical use of these biomarkers to determine prognosis has been proposed, there has been little discussion of how this would be accomplished. This is an important issue because the best translational science occurs when translation is considered early in the research process. The purpose of this clinical focus article is to present a framework to guide the discussion of how neuroimaging biomarkers for recovery from aphasia could be implemented clinically.

Method

The genomics literature reveals that implementing genetic testing in the real-world poses both opportunities and challenges. There is much similarity between these opportunities and challenges and those related to implementing neuroimaging testing to predict recovery in aphasia. Therefore, the Center for Disease Control's model list of questions aimed at guiding the review of genetic testing has been adapted to guide the discussion of using neuroimaging biomarkers as predictors of recovery in aphasia.

Conclusion

The adapted model list presented here is a first and useful step toward initiating a discussion of how neuroimaging biomarkers of recovery could be employed clinically to provide improved quality of care for individuals with aphasia.

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Exploring Treatment Fidelity in Persons With Aphasia Autonomously Practicing With Computerized Therapy Materials

Purpose

Current computer technologies permit independent practice for people with cognitive–communicative disorders. Previous research has investigated compliance rates and outcome changes but not treatment fidelity per se during practice. Our aim was to examine adherence to procedures (treatment fidelity) and accuracy while persons with aphasia independently practiced word production using interactive, multimodal, user-controlled, word-level icons on computers.

Method

Four persons with aphasia independently practiced single-word production after stimulation via user-initiated interactions in 3 conditions: (I) auditory stimulus with static representational drawing; (II) auditory stimulus with synchronized articulation video; and (III) users' choice between the 2 prior conditions. Sessions were video-recorded for subsequent analysis, which established emergently refined behavioral taxonomies using an iterative, mixed-methods approach.

Results

In independent practice, users only sometimes adhere to modeled behaviors, other times improvising novel behaviors. The latter sometimes co-occurred with successful productions. Differences in success rates were noted between Conditions I and II across behaviors with Condition II generally favored. In Condition III, participants tended to choose the stimulus that resulted in highest success rates.

Conclusions

During independent practice with technology, persons with aphasia do not necessarily comply with clinicians' practice instructions, and treatment fidelity does not determine success. Autonomy and choice in practice may reveal unanticipated dimensions for computerized aphasia treatment.

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Effects of Treatment Intensity on Outcomes in Acquired Apraxia of Speech

Purpose

This investigation was designed to examine the effects of treatment intensity (i.e., dose frequency) on the outcomes of Sound Production Treatment (SPT) for acquired apraxia of speech.

Method

Five men with chronic apraxia of speech and aphasia received both intense SPT (3 hr per day/3 days per week) and nonintense/traditional SPT (SPT-T; 1 hr per day/3 days per week) in the context of single-case experimental designs. Each treatment was applied separately to a designated set of experimental words with 1 treatment applied at a time. Twenty-seven treatment sessions were conducted with each phase of treatment. Accuracy of articulation of target sounds within treated and untreated experimental words was measured during the course of the investigation.

Results

All participants demonstrated improved articulation with both treatment intensities. Better maintenance of gains for treated items was found with SPT-T for 2 participants as measured at an 8-week posttreatment retention probe. Superior maintenance of increased accuracy of production of untreated items was also observed with SPT-T for all participants.

Conclusion

A less intense (distributed) application of SPT facilitated better maintenance of improved articulatory accuracy for untreated items, and in some cases treated items, than intense SPT.

Supplemental Materials

https://doi.org/10.23641/asha.5734053

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Reading for Meaning: What Influences Paragraph Understanding in Aphasia?

Purpose

The current study investigated the effect of text variables including length, readability, propositional content, and type of information on the reading comprehension of people with aphasia.

Method

The performance of 75 people with aphasia was compared with 87 healthy, age-matched control participants. Reading comprehension was considered in terms of both accuracy in responding to questions tapping comprehension and reading time. Participants with aphasia (PWA) were divided into 2 groups (no reading impairment [PWA:NRI] and reading impairment [PWA:RI]) depending on whether their performance fell within the 5th percentile of control participants.

Results

As groups, both PWA:NRI and PWA:RI differed significantly from control participants in terms of reading time and comprehension accuracy. PWA:NRI and PWA:RI differed from each other in terms of accuracy but not reading time. There was no significant effect of readability or propositional density on comprehension accuracy or reading time for any of the groups. There was a significant effect of length on reading time but not on comprehension accuracy. All groups found main ideas easier than details, stated information easier than inferred, and had particular difficulty with questions that required integration of information across paragraphs (gist).

Conclusions

Both accuracy of comprehension and reading speed need to be considered when characterizing reading difficulties in people with aphasia.

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Language Changes Following Combined Aphasia and Apraxia of Speech Treatment

Purpose

Combined Aphasia and Apraxia of Speech Treatment (CAAST) is a newly developed treatment shown to increase production of accurate content in narrative discourse for persons with aphasia and apraxia of speech. The purpose of this post hoc study was to further describe lexical and morphosyntactic changes associated with changes in content production.

Method

Existing probe data from 8 persons with aphasia who had completed CAAST were used to complete analyses of morphosyntactic production, lexical diversity, and novelty of content. Language analyses were completed using discourse samples obtained at numerous pretreatment and posttreatment intervals.

Results

All participants demonstrated gains in morphosyntactic language output for treated items, which extended to untreated sets for 7 participants. All 8 increased in production of novel content. Lexical diversity increases were evident for most participants. Although there were some similarities in language changes, there was substantial variability across response profiles.

Conclusion

CAAST, previously associated with positive treatment effects for production of accurate content, also appears to facilitate acquisition and generalization of morphosyntactic complexity, lexical diversity, and novelty of content for individuals with nonfluent aphasia. Further investigation is needed to determine causality and appropriate clinical application.

Supplemental Material

https://doi.org/10.23641/asha.5912530

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Describing Phonological Paraphasias in Three Variants of Primary Progressive Aphasia

Purpose

The purpose of this study was to describe the linguistic environment of phonological paraphasias in 3 variants of primary progressive aphasia (semantic, logopenic, and nonfluent) and to describe the profiles of paraphasia production for each of these variants.

Method

Discourse samples of 26 individuals diagnosed with primary progressive aphasia were investigated for phonological paraphasias using the criteria established for the Philadelphia Naming Test (Moss Rehabilitation Research Institute, 2013). Phonological paraphasias were coded for paraphasia type, part of speech of the target word, target word frequency, type of segment in error, word position of consonant errors, type of error, and degree of change in consonant errors.

Results

Eighteen individuals across the 3 variants produced phonological paraphasias. Most paraphasias were nonword, followed by formal, and then mixed, with errors primarily occurring on nouns and verbs, with relatively few on function words. Most errors were substitutions, followed by addition and deletion errors, and few sequencing errors. Errors were evenly distributed across vowels, consonant singletons, and clusters, with more errors occurring in initial and medial positions of words than in the final position of words. Most consonant errors consisted of only a single-feature change, with few 2- or 3-feature changes. Importantly, paraphasia productions by variant differed from these aggregate results, with unique production patterns for each variant.

Conclusions

These results suggest that a system where paraphasias are coded as present versus absent may be insufficient to adequately distinguish between the 3 subtypes of PPA. The 3 variants demonstrate patterns that may be used to improve phenotyping and diagnostic sensitivity. These results should be integrated with recent findings on phonological processing and speech rate. Future research should attempt to replicate these results in a larger sample of participants with longer speech samples and varied elicitation tasks.

Supplemental Materials

https://doi.org/10.23641/asha.5558107

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Using Images With Individuals With Aphasia: Current Research and Clinical Trends

Purpose

Visuographic supports in the form of images are utilized during assessment and treatment for individuals with aphasia to supplement speech, language, and cognitive losses limiting communication. Clinicians rely on prior experience and intuition to make decisions regarding image-based support design and selection (e.g., augmentative and alternative communication strategies). Researchers have begun to focus on the relationship between the images and the benefits they provide for adults with aphasia.

Method

The aim of this review—resulting from a roundtable discussion at the 2016 Clinical Aphasiology Conference—was to disseminate summaries of current and past researches regarding image use by individuals with aphasia and to highlight areas of need within research and practice.

Results

Review of the literature illuminated 4 major themes: (a) image creation, capture, and sharing; (b) image characteristics; (c) image use across linguistic domains and contexts; and (d) implications for clinical and research practices.

Conclusions

Reviewing current knowledge and practice regarding the use of visual supports for individuals with aphasia is essential to advancing therapeutic practices and providing evidence-based protocols for creating, selecting, and implementing images within augmentative and alternative communication strategies. Several gaps in knowledge were identified as future research needs (e.g., caregiver training and enhanced image feature investigation).

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What Matters in Semantic Feature Analysis: Practice-Related Predictors of Treatment Response in Aphasia

Purpose

This study investigated the predictive value of practice-related variables—number of treatment trials delivered, total treatment time, average number of trials per hour, and average number of participant-generated features per trial—in response to semantic feature analysis (SFA) treatment.

Method

SFA was administered to 17 participants with chronic aphasia daily for 4 weeks. Individualized treatment and semantically related probe lists were generated from items that participants were unable to name consistently during baseline testing. Treatment was administered to each list sequentially in a multiple-baseline design. Naming accuracy for treated and untreated items was obtained at study entry, exit, and 1-month follow-up.

Results

Item-level naming accuracy was analyzed using logistic mixed-effect regression models. The average number of features generated per trial positively predicted naming accuracy for both treated and untreated items, at exit and follow-up. In contrast, total treatment time and average trials per hour did not significantly predict treatment response. The predictive effect of number of treatment trials on naming accuracy trended toward significance at exit, although this relationship held for treated items only.

Conclusions

These results suggest that the number of patient-generated features may be more strongly associated with SFA-related naming outcomes, particularly generalization and maintenance, than other practice-related variables.

Supplemental Materials

https://doi.org/10.23641/asha.5734113

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Links Between Short-Term Memory and Word Retrieval in Aphasia

Purpose

This study explored the relationship between anomia and verbal short-term memory (STM) in the context of an interactive activation language processing model.

Method

Twenty-four individuals with aphasia and reduced STM spans (i.e., impaired immediate serial recall of words) completed a picture-naming task and a word pair repetition task (a measure of verbal STM). Correlations between verbal STM and word retrieval errors made on the picture-naming task were examined.

Results

A significant positive correlation between naming accuracy and verbal span length was found. More intricate verbal STM analyses examined the relationship between picture-naming error types (i.e., semantic vs. phonological) and 2 measures of verbal STM: (a) location of errors on the word pair repetition task and (b) imageability and frequency effects on the word pair repetition task. Results indicated that, as phonological word retrieval errors (relative to semantic) increase, bias toward correct repetition of high-imageability words increases.

Conclusions

Results suggest that word retrieval and verbal STM tasks likely rely on a partially shared temporary linguistic activation process.

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More Than a Story: My Life Came Back to Life

Purpose

Social models of aphasia rehabilitation emphasize the importance of supporting identity renegotiation, which can be accomplished in part through personal narrative construction. The purpose of this study was to examine the experiences of persons who had engaged in a project to coconstruct personal narratives about life with aphasia.

Method

Qualitative interviews were conducted with 3 participants with aphasia who completed a 4-week personal narrative coconstruction project, which included preadministration and postadministration of the Communication Confidence Rating Scale for Aphasia (Cherney & Babbitt, 2011). Results were analyzed using interpretative phenomenological analysis.

Results

Three themes were revealed: (a) More than a story: It changed my life validated the idea that the narrative coconstruction process supported a positive view of identity; (b) A positive experience captured the participants' enjoyment in coconstructing and sharing their story; (c) Hope engendered by the coconstruction experience empowered participants with new levels of confidence not only in their communication skills but also in themselves.

Conclusions

This study provided insight into the experience of coconstructing personal narratives using a structured protocol. Participants experienced the project as a positive, meaningful opportunity to actively contemplate their life and look forward. The study has implications for clinicians considering support of identity renegotiation in aphasia rehabilitation.

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Attentive Reading With Constrained Summarization Adapted to Address Written Discourse in People With Mild Aphasia

Purpose

The purpose of this study was to examine the preliminary efficacy of Attentive Reading and Constrained Summarization–Written (ARCS-W) in people with mild aphasia. ARCS-W adapts an existing treatment, ARCS (Rogalski & Edmonds, 2008), to address discourse level writing in mild aphasia. ARCS-W focuses on the cognitive and linguistic skills required for discourse production.

Method

This study was a within-subject pre–postdesign. Three people with mild aphasia participated. ARCS-W integrates attentive reading or listening with constrained summarization of discourse level material in spoken and written modalities. Outcomes included macro- (main concepts) and microlinguistic (correct information units, complete utterances) discourse measures, confrontation naming, aphasia severity, and functional communication.

Results

All 3 participants demonstrated some generalization to untrained spoken and written discourse at the word, sentence, and text levels. Reduced aphasia severity and/or increased functional communication and confrontation naming were also observed in some participants.

Conclusions

The findings of this study provide preliminary evidence of the efficacy of ARCS-W to improve spoken and written discourse in mild aphasia. Different generalization patterns suggest different mechanisms of improvement. Further research and replication are required to better understand how ARCS-W can impact discourse abilities.

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Analysis of Story Recall in Military Veterans With and Without Mild Traumatic Brain Injury: Preliminary Results

Purpose

The purpose of this study was to determine whether detailed analysis of story recall performance reveals significant differences between veterans with and without history of mild traumatic brain injury (mTBI).

Method

Twenty-one military veterans participated, with 7 reporting history of mTBI. All participants were administered the Logical Memory I and II subtests from the Wechsler Memory Scale–Fourth Edition (Wechsler, 2009). Responses were scored for total correct ideas (TCI) and total words produced (TWP).

Results

Although the groups did not differ in scaled scores, other measures did reveal significant differences. After a delay, the mTBI group showed a greater drop in TCI relative to the control group. Additionally, the control group showed an increase in TWP when the recall was delayed versus immediate; a pattern not observed for the mTBI group.

Conclusions

The mTBI and control groups did not significantly differ in scaled scores. However, group differences were observed in TCI and TWP. The findings suggest that, relative to the control group, the mTBI group were less successful in retrieving episodic information and eliciting self-cueing. Small sample size limited data interpretation, and larger sample sizes are needed to confirm the findings. The results indicate that veterans with mTBI may present with symptoms persisting beyond the acute state of the injury.

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The Relationship Between Confrontation Naming and Story Gist Production in Aphasia

Purpose

The purpose of this study was to examine the relationship between picture naming performance and the ability to communicate the gist, or essential elements, of a story. We also sought to determine if this relationship varied according to Western Aphasia Battery–Revised (WAB-R; Kertesz, 2007) aphasia subtype.

Method

Demographic information, test scores, and transcripts of 258 individuals with aphasia completing 3 narrative tasks were retrieved from the AphasiaBank database. Narratives were subjected to a main concept analysis to determine gist production. A correlation analysis was used to investigate the relationship between naming scores and main concept production for the whole group of persons with aphasia and for WAB-R subtypes separately.

Results

We found strong correlations between naming test scores and narrative gist production for the large sample of persons with aphasia. However, the strength of the correlations varied by WAB-R subtype.

Conclusions

Picture naming may accurately predict gist production for individuals with Broca's and Wernicke's aphasia, but not for other WAB-R subtypes. Given the current reprioritization of outcome measurement, picture naming may not be an appropriate surrogate measure for functional communication for all persons with aphasia.

Supplemental Materials

https://doi.org/10.23641/asha.5851848

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Masthead

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Cytomorphological Spectrum of Thyroiditis: A Review of 110 Cases

Introduction. Different types of thyroiditis may share some parallel clinical and biochemical features. Timely intervention can significantly reduce morbidity and mortality. Aim. Aim of this study is to find the frequency of various thyroiditis, study the cytomorphological features and correlate with clinical findings including radiological findings, thyroid function test, and anti-thyroid peroxidase antibodies (Anti-TPO antibodies). Materials and Methods. The study included consecutive 110 cases of thyroiditis. Detailed cytomorphological features were studied and correlated with ultrasonography findings, thyroid function test, anti-thyroid peroxidase antibodies (anti-TPO) and histopathological features where thyroidectomy specimens were received for histopathological examination. Results. The majority were Hashimoto's thyroiditis () and females (). Other forms of thyroiditis were Hashimoto's thyroiditis with colloid goiter (), De Quervain's thyroiditis (), and one case each of postpartum thyroiditis and Hashimoto's thyroiditis with associated malignancy. The majority of patients were in the age group of 21–40 () and the majority () had diffuse enlargement of thyroid. The majority of patients were hypothyroid (). The serum anti-TPO antibodies were elevated in 47 patients out of 71 patients. In the 48 patients who underwent ultrasonography, 38 were diagnosed as having thyroiditis. The most consistent cytomorphological features seen in fine-needle aspiration smears of Hashimoto's thyroiditis were increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells. Conclusion. The diagnostic cytological features in Hashimoto's thyroiditis are increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells. FNAC remains the "Gold Standard" for diagnosing Hashimoto's thyroiditis. Clinical history, thyroid function, and biochemical parameters are the key for diagnosis of other forms of thyroiditis.

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A study on etiopathogenesis and clinical features of multi-headed (bifid and trifid) mandibular condyles and review of the literature

The formations of second or more condylar heads are considered as rare anomalies. Fourteen multi-headed condyles (MHC) were presented; 13 of these were bifid mandibular condyles (BMC), whereas one exceptionally rare case was a trifid mandibular condyle (TMC). The TMC presented in this paper is the eighth case reported in the literature. In this paper, etiopathogenesis, types, and treatments are discussed.

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How Four Years Have Changed the Field: A Student Perspective

No abstract available

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Managing Single-Sided Deafness and Unilateral Hearing Loss

No abstract available

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Gaps in Evaluating, Managing Hearing Difficulties

No abstract available

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