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Purpose: The aim of this study was to advance the use of structured, monologic discourse analysis by validating an automated scoring procedure for core lexicon (CoreLex) using transcripts. Method: Forty-nine transcripts from persons with aphasia and 48 transcripts from persons with no brain injury were retrieved from the AphasiaBank database. Five structured monologic discourse tasks were scored manually by trained scorers and via automation using a newly developed CLAN command based upon previously published lists for CoreLex. Point-to-point (or word-by-word) accuracy and reliability of the two methods were calculated. Scoring discrepancies were examined to identify errors. Time estimates for each method were calculated to determine if automated scoring improved efficiency. Results: Intraclass correlation coefficients for the tasks ranged from .998 to .978, indicating excellent intermethod reliability. Automated scoring using CLAN represented a significant time savings for an experienced CLAN user and for inexperienced CLAN users following step-by-step instructions. Conclusions: Automated scoring of CoreLex is a valid and reliable alternative to the current gold standard of manually scoring CoreLex from transcribed monologic discourse samples. The downstream time saving of this automated analysis may allow for more efficient and broader utilization of this discourse measure in aphasia research. To further encourage the use of this method, go to https://aphasia.talkbank.org/discourse/CoreLexicon/ for materials and the step-by-step instructions utilized in this project. Supplemental Material: https://doi.org/10.23641/asha.20399304

Purpose Spoken discourse analysis is commonly employed in the assessment and treatment of people living with aphasia, yet there is no standardization in assessment, analysis, or reporting procedures, thereby precluding comparison/meta-analyses of data and hindering replication of findings. An important first step is to identify current practices in collecting and analyzing spoken discourse in aphasia. Thus, this study surveyed current practices, with the goal of working toward standardizing spoken discourse assessment first in research settings with subsequent implementation into clinical settings. Method A mixed-methods (quantitative and qualitative) survey was publicized to researchers and clinicians around the globe who have collected and/or analyzed spoken discourse data in aphasia. The survey data were collected between September and November 2019. Results Of the 201 individuals who consented to participate, 189 completed all mandatory questions in the survey (with fewer completing nonmandatory response questions). The majority of respondents reported barriers to utilizing discourse including transcription, coding, and analysis. The most common barrier was time (e.g., lack of time). Respondents also indicated that there was a lack of, and a need for, psychometric properties and normative data for spoken discourse use in the assessment and treatment of persons with aphasia. Quantitative and qualitative results are described in detail. Conclusions The current survey study evaluated spoken discourse methods in aphasia across research and clinical settings. Findings from this study will be used to guide development of process standardization in spoken discourse and for the creation of a psychometric and normative property database. Supplemental Material https://doi.org/10.23641/asha.16639510

AphasiaBank is a shared, multimedia database for the study of communication in aphasia. This article describes a variety of discourse measurement tools and teaching resources available at the AphasiaBank website. The discourse measurement tools include main concept analysis, core lexicon checklists, correct information unit computation techniques, and other automated analyses using the CLAN program. These tools can be used to measure a variety of aspects of language production for assessment as well as treatment evaluation and clinical research purposes. Importantly, they are intended to help make the discourse analysis process more efficient and reliable. Teaching resources include an online tutorial on aphasia, videos of typical behaviors seen in aphasia, group treatment videos, classroom activities, tutorial screencasts, and conference posters. These resources can be used for a variety of clinical and educational purposes. The AphasiaBank website is part of the larger TalkBank project which provides many other shared databases and resources that are relevant to professionals interested in communication and communication disorders.

Purpose This clinical focus article describes the development and use of the Famous People Protocol (FPP), a clinical tool for observing the strategies people with severe aphasia (PWSA) can use to communicate when speech is limited. Its goal is to provide a systematic approach to identifying individually appropriate communication strategies for PWSA. Method Though not a test, the FPP's development and pilot testing were consonant with qualitative approaches to test development. Eighty-one people with aphasia and 37 nonaphasic participants were given the current version of FPP and the Western Aphasia Battery–Revised (WAB-R; Kertesz, 2006 ). This clinical focus article reports on the 36 PWA who scored near or below the mean WAB score of the larger group. Results The FPP has a maximum score of 100 based on (a) identification of famous people in different categories, entertainers, athletes, U.S. presidents, sports figures, and internationally famous people, and (b) responses to additional questions about the famous people. Identification is scored quantitatively on a 3-point scale, and question responses are scored correct (1) or incorrect (0). Mean scores for the PWSA and control groups were 54.6 and 95.2, respectively. FPP and WAB-R scores were moderately correlated ( r = .67). Qualitative results describe the variety of strategies that PWSA used on the FPP. Conclusions The FPP is a way for clinicians to engage PWSA in an activity that can reveal personally relevant strategies to help PWSA communicate more effectively. The strategies can then become the basis for subsequent training on using them conversationally. Appendixes provide examples of clinical approaches.

Purpose Analysis of spontaneous speech samples is important for determining patterns of language production in people with aphasia. To accomplish this, researchers and clinicians can use either hand coding or computer-automated methods. In a comparison of the two methods using the hand-coding NNLA (Northwestern Narrative Language Analysis) and automatic transcript analysis by CLAN (Computerized Language Analysis), Hsu and Thompson (2018) found good agreement for 32 of 51 linguistic variables. The comparison showed little difference between the two methods for coding most general (i.e., utterance length, rate of speech production), lexical, and morphological measures. However, the NNLA system coded grammatical measures (i.e., sentence and verb argument structure) that CLAN did not. Because of the importance of quantifying these aspects of language, the current study sought to implement a new, single, composite CLAN command for the full set of 51 NNLA codes and to evaluate its reliability for coding aphasic language samples. Method Eighteen manually coded NNLA transcripts from eight people with aphasia and 10 controls were converted into CHAT (Codes for the Human Analysis of Talk) files for compatibility with CLAN commands. Rules from the NNLA manual were translated into programmed rules for CLAN computation of lexical, morphological, utterance-level, sentence-level, and verb argument structure measures. Results The new C-NNLA (CLAN command to compute the full set of NNLA measures) program automatically computes 50 of the 51 NNLA measures and generates the results in a summary spreadsheet. The only measure it does not compute is the number of verb particles. Statistical tests revealed no significant difference between C-NNLA results and those generated by manual coding for 44 of the 50 measures. C-NNLA results were not comparable to manual coding for the six verb argument measures. Conclusion Clinicians and researchers can use the automatic C-NNLA to analyze important variables required for quantification of grammatical deficits in aphasia in a way that is fast, replicable, and accessible without extensive linguistic knowledge and training.

This work focuses on the twenty-six individuals who provided data to AphasiaBank on at least two occasions, with initial testing between 6 months and 5.8 years post-onset of aphasia. The data are archival in nature and were collected from the extensive database of aphasic discourse in AphasiaBank.The aim is to furnish data on the nature of long-term changes in both the impairment of aphasia as measured by the Western Aphasia Battery-Revised (WAB-R) and its expression in spoken discourse.AphasiaBank's demographic database was searched to discover all individuals who were tested twice at an interval of at least a year with either: 1) the AphasiaBank protocol; or 2) the AphasiaBank protocol at first testing, and the Famous People Protocol (FPP) at second testing. The Famous People Protocol is a measure developed to assess the communication strategies of individuals whose spoken language limitations preclude full participation in the AphasiaBank protocol. The 26 people with aphasia (PWA) who were identified had completed formal speech therapy before being seen for AphasiaBank. However, all were participants in aphasia centers where at least three hours of planned activities were available, in most cases, twice weekly. WAB-R Aphasia Quotient scores (AQ) were examined, and in those cases where AQ scores improved, changes were assessed on a number of measures from the AphasiaBank discourse protocol.Sixteen individuals demonstrated improved WAB-R AQ scores, defined as positive AQ change scores greater than the WAB-R AQ standard error of the mean (WAB-SEM); seven maintained their original WAB quotients, defined as AQ change scores that were not greater than the WAB-SEM; and the final three showed negative WAB-R change scores, defined as a negative WAB-R AQ change score greater than the WAB-SEM. Concurrent changes on several AphasiaBank tasks were also found, suggesting that the WAB-R improvements were noted in more natural discourse as well.These data are surprising, since conventional wisdom suggests that spontaneous improvement in language is unlikely to occur beyond one year. Long-term improvement or maintenance of early test scores, such as that shown here, has seldom been demonstrated in the absence of formal treatment. Speculations about why these PWA improved, maintained or declined in their scores are considered.

Purpose This study examined discourse characteristics of individuals with aphasia who scored at or above the 93.8 cutoff on the Aphasia Quotient subtests of the Western Aphasia Battery–Revised (WAB-R; Kertesz, 2007). They were compared with participants without aphasia and those with anomic aphasia. Method Participants were from the AphasiaBank database and included 28 participants who were not aphasic by WAB-R score (NABW), 92 participants with anomic aphasia, and 177 controls. Cinderella narratives were analyzed using the Computerized Language Analysis programs (MacWhinney, 2000). Outcome measures were words per minute, percent word errors, lexical diversity using the moving average type–token ratio (Covington, 2007b), main concept production, number of utterances, mean length of utterance, and proposition density. Results Results showed that the NABW group was significantly different from the controls on all measures except MLU and proposition density. These individuals were compared to participants without aphasia and those with anomic aphasia. Conclusion Individuals with aphasia who score above the WAB-R Aphasia Quotient cutoff demonstrate discourse impairments that warrant both treatment and special attention in the research literature.

In accord with articles 19 and 27 of the Universal Declaration of Human Rights, people with speech and language disorders have the right to receive maximal benefit from academic research on speech and language acquisition and disorders. To evaluate the diverse nature of speech and language disorders, this research must have access to large datasets, as well as to refined tools for the systematic analysis of these datasets. The TalkBank system addresses this need by providing researchers with thousands of hours of open-access database archives of digital audio, video and transcript files documenting typical and disordered language use in dozens of languages and cultures. In this paper, we review the TalkBank system, with an emphasis on the AphasiaBank, PhonBank and FluencyBank databases. We describe how specialised assessment tools can be used to study issues in speech and language acquisition and disorders recorded within these databases. We then provide illustrations of how assessments support the needs of researchers, clinicians, developers, and educators, whose combined work contributes solutions for people with speech, language and language learning disorders worldwide.

PurposeThe 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.MethodDemographic 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.ResultsWe 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.ConclusionsPicture 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 Materialshttps://doi.org/10.23641/asha.5851848

A distinguishing feature of Broca’s aphasia is non-fluent halting speech typically involving one to three words per utterance. Yet, despite such profound impairments, some patients can mimic audio-visual speech stimuli enabling them to produce fluent speech in real time. We call this effect ‘speech entrainment’ and reveal its neural mechanism as well as explore its usefulness as a treatment for speech production in Broca’s aphasia. In Experiment 1, 13 patients with Broca’s aphasia were tested in three conditions: (i) speech entrainment with audio-visual feedback where they attempted to mimic a speaker whose mouth was seen on an iPod screen; (ii) speech entrainment with audio-only feedback where patients mimicked heard speech; and (iii) spontaneous speech where patients spoke freely about assigned topics. The patients produced a greater variety of words using audio-visual feedback compared with audio-only feedback and spontaneous speech. No difference was found between audio-only feedback and spontaneous speech. In Experiment 2, 10 of the 13 patients included in Experiment 1 and 20 control subjects underwent functional magnetic resonance imaging to determine the neural mechanism that supports speech entrainment. Group results with patients and controls revealed greater bilateral cortical activation for speech produced during speech entrainment compared with spontaneous speech at the junction of the anterior insula and Brodmann area 47, in Brodmann area 37, and unilaterally in the left middle temporal gyrus and the dorsal portion of Broca’s area. Probabilistic white matter tracts constructed for these regions in the normal subjects revealed a structural network connected via the corpus callosum and ventral fibres through the extreme capsule. Unilateral areas were connected via the arcuate fasciculus. In Experiment 3, all patients included in Experiment 1 participated in a 6-week treatment phase using speech entrainment to improve speech production. Behavioural and functional magnetic resonance imaging data were collected before and after the treatment phase. Patients were able to produce a greater variety of words with and without speech entrainment at 1 and 6 weeks after training. Treatment-related decrease in cortical activation associated with speech entrainment was found in areas of the left posterior-inferior parietal lobe. We conclude that speech entrainment allows patients with Broca’s aphasia to double their speech output compared with spontaneous speech. Neuroimaging results suggest that speech entrainment allows patients to produce fluent speech by providing an external gating mechanism that yokes a ventral language network that encodes conceptual aspects of speech. Preliminary results suggest that training with speech entrainment improves speech production in Broca’s aphasia providing a potential therapeutic method for a disorder that has been shown to be particularly resistant to treatment. * Abbreviations : DTI : diffusion tensor imaging FSL : FMRIB Software Library

PURPOSE: This study examined responses of persons with aphasia (PWAs) to a general question about their speech. The goal was to describe their evaluative responses as positive, negative, or neutral/mixed and determine if responses differed, based on time post-onset, aphasia severity, and aphasia type. METHODS: 71 participants from the AphasiaBank project were included. As part of a larger protocol, investigators asked, "How do you think your speech is these days?" Responses were videotaped and transcribed using CLAN. Two authors coded the evaluative responses and categorized themes in the elaborative content provided by the participants. RESULTS: Positive responses accounted for 59% of all responses, followed by neutral/mixed (18%), and negative (17%). Participants also mentioned specific speech problems (35%), improvement (31%), and therapy (8%) in their responses. Time post-onset and aphasia type were not significantly associated with nature of response. Aphasia severity was significantly associated with nature of response, with higher AQ scores in the positive group and vice versa. CONCLUSIONS: The responses are discussed in the context of self-image and self-expression in PWA and social models in aphasia therapy. Results are also compared with those of others with chronic disabilities and research on resilience, positive affect, and optimism.

BACKGROUND: AphasiaBank is a computerized database of interviews between persons with aphasia (PWAs) and clinicians. By February 2011, the database had grown to include 145 PWAs and 126 controls from 12 sites across the United States. The data and related analysis programs are available free over the web. AIMS: The overall goal of AphasiaBank is the construction of a system for accumulating and sharing data on language usage by PWAs. To achieve this goal, we have developed a standard elicitation protocol and systematic automatic and manual methods for transcription, coding, and analysis. METHODS #ENTITYSTARTX00026; PROCEDURES: We present sample analyses of transcripts from the retelling of the Cinderella story. These analyses illustrate the application of our methods for the study of phonological, lexical, semantic, morphological, syntactic, temporal, prosodic, gestural, and discourse features. MAIN CONTRIBUTION: AphasiaBank will allow researchers access to a large, shared database that can facilitate hypothesis testing and increase methodological replicability, precision, and transparency. CONCLUSIONS: AphasiaBank will provide researchers with an important new tool in the study of aphasia.

Background: AphasiaBank is a collaborative project whose goal is to develop an archival database of the discourse of individuals with aphasia. Along with databases on first language acquisition, classroom discourse, second language acquisition, and other topics, it forms a component of the general TalkBank database. It uses tools from the wider system that are further adapted to the particular goal of studying language use in aphasia. Aims: The goal of this paper is to illustrate how TalkBank analytic tools can be applied to AphasiaBank data. Methods &Procedures: Both aphasic (n = 24) and non-aphasic (n = 25) participants completed a 1-hour standardised videotaped data elicitation protocol. These sessions were transcribed and tagged automatically for part of speech. One component of the larger protocol was the telling of the Cinderella story. For these narratives we compared lexical diversity across the groups and computed the top 10 nouns and verbs across both groups. We then examined the profiles for two participants in greater detail. Conclusions: Using these tools we showed that, in a story-retelling task, aphasic speakers had a marked reduction in lexical diversity and a greater use of light verbs. For example, aphasic speakers often substituted “girl” for “stepsister” and “go” for “disappear”. These findings illustrate how it is possible to use TalkBank tools to analyse AphasiaBank data.

AphasiaBank has used a standardized protocol to collect narrative, procedural, personal, and descriptive discourse from 290 persons with aphasia, as well as 190 control participants. These data have been transcribed in the Codes for the Human Analysis of Transcripts (CHAT) format for analysis by the Computerized Language Analysis (CLAN) programs. Here, we review results from 45 studies based on these data that investigate aphasic productions in terms of these eight areas: discourse, grammar, lexicon, gesture, fluency, syndrome classification, social factors, and treatment effects. For each area, we also indicate how use of the CLAN programs has facilitated the analysis. We conclude with an examination of ways in which the size of the database could be increased through on-site recordings and data from teletherapy.

Purpose This study evaluates how proposition density can differentiate between persons with aphasia (PWA) and individuals in a control group, as well as among subtypes of aphasia, on the basis of procedural discourse and personal narratives collected from large samples of participants. Method Participants were 195 PWA and 168 individuals in a control group from the AphasiaBank database. PWA represented 6 aphasia types on the basis of the Western Aphasia Battery–Revised (Kertesz, 2006). Narrative samples were stroke stories for PWA and illness or injury stories for individuals in the control group. Procedural samples were from the peanut-butter-and-jelly-sandwich task. Language samples were transcribed using Codes for the Human Analysis of Transcripts (MacWhinney, 2000) and analyzed using Computerized Language Analysis (MacWhinney, 2000), which automatically computes proposition density (PD) using rules developed for automatic PD measurement by the Computerized Propositional Idea Density Rater program (Brown, Snodgrass, & Covington, 2007; Covington, 2007). Results Participants in the control group scored significantly higher than PWA on both tasks. PD scores were significantly different among the aphasia types for both tasks. Pairwise comparisons for both discourse tasks revealed that PD scores for the Broca's group were significantly lower than those for all groups except Transcortical Motor. No significant quadratic or linear association between PD and severity was found. Conclusion Proposition density is differentially sensitive to aphasia type and most clearly differentiates individuals with Broca's aphasia from the other groups.

AphasiaBank is a shared, multimedia database containing videos and transcriptions of ~180 aphasic individuals and 140 nonaphasic controls performing a uniform set of discourse tasks. The language in the videos is transcribed in Codes for the Human Analysis of Transcripts (CHAT) format and coded for analysis with Computerized Language ANalysis (CLAN) programs, which can perform a wide variety of language analyses. The database and the CLAN programs are freely available to aphasia researchers and clinicians for educational, clinical, and scholarly uses. This article describes the database, suggests some ways in which clinicians and clinician researchers might find these materials useful, and introduces a new language analysis program, EVAL, designed to streamline the transcription and coding processes, while still producing an extensive and useful language profile.

This article presents a brief overview of aphasia, followed by a summary of research studies and program evaluation data addressed to answering the question of the efficacy of treatment for aphasia. Selected studies are reviewed in terms of the quality of evidence they present. In addition, a number of questions that remain unanswered are also presented. Several tables, designed to provide clarifying information concerning several aspects of research design (number and types of patients studied, examples of well-designed small-group or single-subject studies, clinical techniques for which efficacy data are available), are included. The conclusion of this review is that, generally, treatment for aphasia is efficacious.

The paper presents a daily analysis of the language recovery of a patient who was globally aphasic at the time of her first observation and who had recovered language, as measured by the Western Aphasia Battery, at the time of her discharge 14 days later. The paper emphasizes the relatively regular growth of normal syntactic, lexical, and pragmatic features coupled with similar regular decreases in aphasic features. Observations of both phenomena are necessary to describe language recovery.

Twenty-five "experts" on neurogenic motor speech disorders participated in a tutorial exercise. Each was given information on M, a patient who had communication difficulties as the result of stroke, and asked to complete a questionnaire about his problem. The information included a detailed case description, an audiotape of M's speech obtained at 4, 9, 13, and 17 days post-stroke, and test results from the Western Aphasia Battery, the Token Test, and a battery for apraxia of speech. The experts were in excellent agreement on M's primary problem, although it was called by seven different names. The experts were in poor agreement on his secondary problem(s), e.g., the presence and type of aphasia and dysarthria. The results suggest that labeling is difficult, even for "experts." Furthermore, the practicing clinician needs to be sensitive to the likelihood of more than one coexisting problem.

Two simple exploratory statistical techniques, stem and leaf displays and box plots, are described and applied to the analysis of Western Aphasia Battery Cortical Quotient scores for 111 acute stroke patients. A stem and leaf display highlights the shape of a distribution of data and is useful for quickly ordering and displaying data in the form of a frequency distribution; box plots focus special attention on the tails of a distribution and are valuable for summarizing, analyzing, and comparing group data. These methods were used to determine an internal Cortical Quotient cutoff score to distinguish between normal and cognitively impaired patients. The utility of this Cortical Quotient cutoff score and the relevance of these statistical techniques to other research in communicative disorders are discussed.

This study investigated functional communication skills in subjects with mild (n = 26) and moderate (n = 22) Alzheimer's disease (AD) and compared their performance with that of normal elderly (n = 26), Wernicke's aphasic (n = 26), and elderly depressed (n = 15) subjects. Communicative Abilities in Daily Living (CADL) (Holland, 1980), a formal test of functional communication, was administered to all subjects. Subjects with mild and moderate AD were impaired on the CADL, and the impairment was more severe in the moderately demented group than in the mildly demented group. In addition, functional language skills were impaired in elderly depressed subjects as compared with normal elderly control subjects; however, the elderly depressed subjects were less impaired than were the mild AD subjects. The depressed subjects responded incompletely rather than in the irrelevant, vague, rambling style that characterized the AD subjects. Finally, although performance of the moderate AD and Wernicke's aphasic subjects did not differ in terms of total CADL score, the performance of these groups across pragmatic categories and types of error responses were markedly different.