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The subjective experience of neurological symptoms provides useful information for assessment, intervention and care. However, research in the subjective experience of aphasia is limited. Word production difficulties are universal to aphasia, and interdisciplinary research has produced sophisticated models of the multiple stages and processes involved. Critically, this word-production research does not incorporate the subjective experience of symptoms. We carried out a metaphor-led discourse analysis on autobiographical accounts written by people with aphasia, to determine whether subjective descriptions of word finding difficulties are consistent with the stages and processes of psycholinguistic models. Metaphor-led discourse analysis was used to identify, code and interpret metaphorical expressions describing word production difficulties in 12 English-language autobiographical accounts written by people with aphasia. These expressions were then analysed to determine the systematic metaphors (i.e., the related concepts which are used consistently to describe a particular topic). Two distinct types of systematic metaphor emerged in the analysis: conventional systematic metaphors frequently recurring throughout all or most of the accounts; novel systematic metaphors used in one or two extended passages in an overlapping subset of the accounts. 4020 metaphorical expressions described word production, predominantly using conventional metaphors about communication and cognition. The conventional metaphor WORD-PRODUCTION AS MOVING OBJECTS OUT OF A CONTAINER was the most prevalent, with elaborations and variations allowing mapping of different symptoms. Other conventional metaphors included: WORD PRODUCTION AS A JOURNEY/HUNTING/HERDING THROUGH A LANDSCAPE, allowing description of effortful or partial retrieval, neuroplastic recovery, and internal strategies; APHASIA AS BODILY IMPAIRMENT, which described various symptoms in terms of different body parts, including self-monitoring difficulties; and APHASIA AS FRAGMENTATION AND PERSONIFICATION OF SELF and SELF AS MACHINE/COMPUTER to describe a disrupted sense of agency and attention. Novel systematic metaphors were used to describe certain symptoms: APHASIA AS SILENCE and APHASIA AS SPIRITUAL EXPERIENCE were used to describe a lack of 'inner speech', and APHASIA AS A DISMEMBERED TREE to describe problems making semantic associations. This research demonstrates the many consistencies of subjective descriptions of word production difficulties in aphasia with theoretical models, but also shows that some subjectively salient symptoms, in particular attentional and self-monitoring difficulties, and a lack of inner speech, are not captured by all theoretical models. Careful attention to the way that people with aphasia describe their symptoms can provide a valuable source of information to be integrated with objective measures. [ABSTRACT FROM AUTHOR]

BackgroundAimsMethods & ProceduresResults & DiscussionConclusionsInner speech in aphasia is a rapidly expanding research area, but can be defined in numerous ways. Unlike behaviourally observable language processes such as overt word-production, inner speech is only directly available to introspection. Subjective experience thus grounds our understanding of inner speech and is a necessary starting point for investigating its definition. Descriptions of inner speech written by people with aphasia can make an important contribution to conceptual clarity in the literature. This important data source has not been systematically analysed. Our research addresses this gap.This research aims to understand the subjective experience of impaired and preserved inner speech in aphasia, through analysis of the metaphors used in autobiographical accounts, and to interpret the findings in relation to the inner speech literature.This study carries out a metaphor-led discourse analysis of descriptions of inner speech in four autobiographical accounts of aphasia. Metaphorical expressions describing language processing were identified and coded, then systematic metaphors (i.e. the related concepts which are used consistently to describe a particular topic) were described. The metaphors used to describe inner speech were then analysed, with attention to patterns of use and contextual information.338 expressions made use of the main systematic metaphors which were used to describe inner speech. Two types of inner speech- Phonological Inner Speech and Dialogic Inner Speech – were described as distinct and dissociable experiences, and were described using different metaphors. Phonological Inner Speech, the internal activation of phonological representations, as used in mental repetition of a word or phrase, was described by two authors using the metaphors WORDS AS OBJECTS, MIND AS CONTAINER and INNER SPEECH AS HEARING WORDS. Dialogic Inner Speech, the use or awareness of linguistic inner reasoning or dialogue, was described by two different authors using the metaphors INNER SPEECH AS INNER VOICES/PERSONS/MONOLOGUE/DIALOGUE and APHASIA AS SILENCE/FLUID/SPIRITUAL EXPERIENCE. A double dissociation of these different definitions of inner speech is seen across two of the accounts. Different impacts on language processing and cognition were also described.This research demonstrates that subjective accounts of inner speech can help clarify theoretical discussions and clinical implications. Although recent research within aphasiology has focused mainly on Phonological Inner Speech, we show that in these accounts the impairment of Dialogic Inner Speech was described as more salient and more explicitly as a “lack of inner voices”. [ABSTRACT FROM AUTHOR]

Background: The evidence-base of therapy studies for reading difficulties is notably sparse, particularly for individuals with deep dyslexia. Research using grapheme-to-phoneme correspondence approaches to remediate the non-lexical reading route in deep dyslexia have been reported but with limited therapy success. The approach of bigraph-syllable blending training has met with some success enabling individuals with deep dyslexia to read single words containing these bigraphs. Aims: This study compares the effects of the bigraph-syllable pairing training method on oral reading for mid-high and low-frequency bigraphs in training and generalization items in an individual with deep dyslexia (DT). To inform the clinical practice, we also analysed DT's ability to engage with the therapy cues (i.e. ability to process, generate and utilize the cues) to determine the most responsive component of the cueing hierarchy. Methods & Procedures: Detailed assessment indicated that DT showed deep dyslexia with severe difficulties reading non-words, alongside imageability effects and production of semantic errors. A single-subject multiple probe across behaviour design was employed to evaluate the efficacy of bigraph-syllable pairing therapy for training and generalization of bigraph sets containing mid-high and low-frequency bigraphs. DT's engagement with the therapy cues were tracked across each of the therapy sessions. Generalisation effects were evaluated by measuring performance on untrained bigraph stimuli and change in performance from pre- to post-therapy on single word reading subtests. Outcomes & Results: Results reveal that post-therapy DT showed improvement in reading aloud for both mid-high and low frequency trained bigraphs, albeit to a different degree. Mid-high frequency bigraphs showed greater therapy effects than the low-frequency bigraphs. DT demonstrated that writing and copying were the most beneficial cues in supporting DT's oral reading of bigraphs. He did not show any generalization to untrained bigraphs, but illustrated a reduction in imageability effects with improved reading accuracy for low-imageability single words, and improved ability to name letters. Post-therapy, he showed a significant reduction in omission errors and a significant increase in unclassifiable errors in reading aloud. Conclusions & Implications: This study demonstrated the efficacy of bigraph-syllable pairing training for improving oral reading abilities and reducing the imageability effects in an individual with deep dyslexia. The findings from client's responsiveness with different cues during the therapy showed that writing and coping is a useful strategy for improving reading aloud abilities. [ABSTRACT FROM AUTHOR]

Background: Speech and Language Therapists (SLTs) play a vital role in supporting people with aphasia to communicate. Recent studies have shown that despite SLTs' expertise, skills, and knowledge to support people with aphasias' communication needs; they are not regularly involved in the decision-making and capacity (DMC) assessments for people with aphasia. Literature suggests three key contributors to this under-involvement: (1) SLTs do not feel they understand their role in a DMC assessment, (2) they do not feel there is enough profession-specific training, and (3) they feel members of the multidisciplinary team do not fully understand their role and responsibilities to involve them in the process. Aims: This research reports the development of a profession-specific DMC training programme for SLT trainees, and its implementation to document change in their confidence, knowledge and understanding of the DMC process in people with aphasia. Methods & Procedures: Thirty-nine SLT students attended a two-hour DMC training session conducted in three phases: pre-training questionnaire, the training programme, and the post-training questionnaire. Topics in the training programme included: the knowledge and tenets of the Mental Capacity Act (MCA); DMC for people with aphasia, focusing specifically on the barriers faced by people with aphasia and professionals; the SLTs' role within a multidisciplinary team regarding DMC assessments; and resources available for facilitating DMC assessments. The change in participants score from pre- to post-training questionnaire was taken as a measure of efficacy of the training programme. Outcomes & Results: Following training there was a significant increase in the confidence levels of SLT students in terms of ability to complete capacity assessments and train others in their role within a capacity assessment. Participants also had a better understanding of the MCA and an increased knowledge of resources available to support people with aphasia in these assessments. These results demonstrate a crucial need for profession-specific training, which has implications for inter-professional education. Conclusions: The findings highlight the effectiveness of a short training session in increasing SLT trainees' knowledge and confidence in DMC for aphasia, and improving their understanding of SLTs' role and responsibilities. It is anticipated that this type of training will place SLTs in a better position for future clinical practice, reducing the risks currently present not only to patients, but also to staff themselves. We propose that similar training programmes should become mandatory for SLT trainees as part of their clinical training. [ABSTRACT FROM AUTHOR]

Background: Individuals’ right to be involved with decisions regarding their health and social care is the cornerstone for modern patient-centred care. Decision-making is a complex process that involves multiple cognitive and linguistic abilities. These are often challenging for people with aphasia (PWA). The Mental Capacity Act (MCA) Code of Practice (2007) recommends that speech and language therapists (SLTs) support capacity assessments for individuals with communication problems, such as PWA. To date, little is known regarding SLTs’ involvement in the UK for supporting decision-making and capacity assessment for PWA. Aims: This research provides data to document when, how, and the extent to which SLTs are being used in capacity assessment for PWA in England. We also determined SLTs’ training and resource needs in capacity assessments, and their role in inter-professional training. Methods & Procedures: 56 SLTs working with PWA from a wide range of clinical settings in England were recruited; they completed a secure questionnaire using the online survey tool Survey Monkey. The questionnaire collected information in the following areas: knowledge and awareness of the MCA; current involvement of SLTs in capacity assessments and decision-making; inter-professional understanding of SLTs roles in capacity assessments; and training needs of SLTs. Outcomes & Results: The SLTs who participated in this survey indicated that they were not regularly involved to support capacity assessment for PWA. Moreover, they also reported that other professionals on the care team did not fully recognise or utilise their skills in supporting capacity assessment for PWA. Moreover, SLTs were not solicited to train professionals regarding communication difficulties in aphasia and its impact on capacity assessments. SLTs wanted profession-specific training to fulfil the role of supporting PWA in capacity assessments more effectively and reliably. Conclusions: Healthcare professionals have an ethical duty to ensure that judgements of capacity are unbiased and accurate. SLTs have an important contribution to make but their skills and knowledge are not fully recognised or utilised. These findings highlight an important need to raise the profile of SLTs’ skills and expertise amongst professionals through education and/or inter-professional communications. This would enable SLTs to be regularly and effectively utilised in capacity assessments and decision-making for PWA. [ABSTRACT FROM PUBLISHER]

Background: Images are essential materials for assessment and rehabilitation in aphasia. Psycholinguistic research has identified name agreement (the degree to which different people agree on a particular name for a particular image) to be a strong predictor of picture naming in healthy individuals in a wide variety of languages. Despite its significance in naming performance and its impact across linguistic families, studies investigating the effects of name agreement in neuropsychological populations are limited. Determining the impact of name agreement in neuropsychological populations can inform us about lexical processing, which in turn can aid in development of improved assessment and rehabilitation materials. Aims: To compare the naming accuracy and error profile in naming high versus low name agreement (HighNA and LowNA) images in people with aphasia (PWA) and in healthy Adults (HA). Methods & Procedures: Participants were 10 PWA and 21 age- and gender-matched HA. Stimuli were black-and-white line drawings of 50 HighNA images (e.g., acorn, bell) and 50 LowNA images (e.g., jacket, mitten). The image sets were closely matched on a range of image and lexical variables. Participants were instructed to name the drawings using single words. Responses were coded into exclusive categories: correct, hesitations, alternate names, visual errors, semantic errors and omissions. Outcomes and Results: HighNA images were named more accurately than LowNA images; the HA group had higher accuracy than the PWA group; there was a significant interaction in which the name agreement effect was stronger in HA than in PWA. In individual analyses, 7 of 10 PWA participants showed the group pattern of higher accuracies for HighNA, whilst 3 PWA did not. HighNA and LowNA images gave rise to more alternate names in HA than in PWA. There were also fewer visual errors, and more omissions, in PWA than in HA, but only for LowNA items. Conclusions: Name agreement produced measurable differences in naming accuracy for both HA and PWA. PWA shows a reduced effect of name agreement and exhibit a different pattern of errors, compared to healthy controls. We speculate that in picture naming tasks, lower name agreement increases competitive lexical selection, which is difficult for PWA to resolve. In preparation of clinical materials, we need to be mindful of image properties. Future research should replicate our findings in a larger population, and a broader range of pathologies, as well as determine the executive mechanisms underpinning name agreement effects. [ABSTRACT FROM AUTHOR]

Background: Although aphasia affects quality of life (QoL), the impact within specific domains (e.g., psychosocial, communication) is poorly understood. Moreover, the complex and multidimensional nature of QoL renders it difficult to measure accurately using a single global scale. Aims: Using two recently developed QoL scales, the Stroke and Aphasia Quality of Life Scale-39, (SAQOL; Hilari, Byng, Lamping, & Smith, 2003a) and the American Speech Language Hearing Association's Quality of Communication Life Scale (QCL; Paul et al., 2004), this study aimed to document the domains of QoL that were most affected for participants with aphasia compared to control participants, as well as to determine the relationship between the two scales, their sub-domains, and linguistic variables in aphasia. Methods & Procedures: The two scales were administered to a group of 19 participants with aphasia (14 male, 5 female), ages ranging from 27 to 79 years, and 19 age- and gender-matched control participants. Various types and severity of aphasia were represented in the aphasia group. The performances of aphasia and control groups were compared, and correlation analyses examined the relationship between the two scales and their sub-domains in the aphasia group only. Outcomes & Results: Compared to control participants, QoL was lower in participants with aphasia, with the communication sub-domain of SAQOL and socialisation/activities sub-domain of QCL being the most affected areas of functioning. Between the two scales, the communication sub-domain of SAQOL correlated with the socialisation/activities sub-domain and the QCL mean. Moreover, linguistic variables correlated strongly with psychosocial, communication and socialisation/activities sub-domains of QoL. Conclusions: Measuring QoL using the SAQOL and the QCL captures different but equally important aspects of experiences of living with aphasia. When interpreted together, they provide a holistic picture of functioning in aphasia that includes broad overviews of QoL from the SAQOL and a finer-grained analysis of communication impairments on QoL from the QCL. [ABSTRACT FROM AUTHOR]

Apraxia of speech (AOS) is typically described as a motor-speech disorder with clinically well-defined symptoms, but without a clear understanding of the underlying problems in motor control. A number of studies have compared the speech of subjects with AOS to the fluent speech of controls, but only a few have included speech movement data and if so, this was primarily restricted to the study of single articulators. If AOS reflects a basic neuromotor dysfunction, this should somehow be evident in the production of both dysfluent and perceptually fluent speech. The current study compared motor control strategies for the production of perceptually fluent speech between a young woman with apraxia of speech (AOS) and Broca's aphasia and a group of age-matched control speakers using concepts and tools from articulation-based theories. In addition, to examine the potential role of specific movement variables on gestural coordination, a second part of this study involved a comparison of fluent and dysfluent speech samples from the speaker with AOS. Movement data from the lips, jaw and tongue were acquired using the AG-100 EMMA system during the reiterated production of multisyllabic nonwords. The findings indicated that although in general kinematic parameters of fluent speech were similar in the subject with AOS and Broca's aphasia to those of the age-matched controls, speech task-related differences were observed in upper lip movements and lip coordination. The comparison between fluent and dysfluent speech characteristics suggested that fluent speech was achieved through the use of specific motor control strategies, highlighting the potential association between the stability of coordinative patterns and movement range, as described in Coordination Dynamics theory. [ABSTRACT FROM AUTHOR]

This study investigated a new treatment in which sentence production abilities were trained in a small group of individuals and nonfluent aphasia. It was based upon a mapping therapy approach which holds that sentence production and comprehension impairments are due to difficulties in mapping between the meaning form (thematic roles) and the syntactic form of sentences. We trained production of both canonical and noncanonical reversible sentences. Three patients received treatment and two served as control participants. Patients who received treatment demonstrated acquisition of all trained sentence structures. They also demonstrated across-task generalisation of treated and some untreated sentence structures on two tasks of constrained sentence production, and showed some improvements on a narrative task. One control participant improved on some of these measures and the other did not. There was no noted improvement in sentence comprehension abilities following treatment. Results are discussed with reference to the heterogeneity of underlying impairments in sentence production impairments in nonfluent patients, and the possible mechanisms by which improvement in sentence production might have been achieved in treatment. [ABSTRACT FROM AUTHOR]

This research examined the effectiveness of PROMPT treatment, a tactile–kinaesthetic speech motor treatment, on the acquisition and generalisation of precision and automaticity of speech movements in an individual with Broca's aphasia and apraxia of speech. Using a single subject multiple probe design across behaviours, treatment effects and generalisation were examined for three linguistically different forms of sentences including imperatives, active declaratives, and interrogatives. Results indicated improved speech precision and sequencing of speech movements for trained and untrained sentences for imperative and active declarative forms only. There was no effect of treatment on the interrogatives. Findings are discussed in the context of motor facilitation and its relationship to the linguistic complexity of utterances. Furthermore, the relevance of the interface between motor– linguistic processes in individuals with aphasia and apraxia of speech and implications for resource allocation constructs are addressed. [ABSTRACT FROM AUTHOR]