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BackgroundFor stroke, traumatic brain injury (TBI), and other neurologic conditions associated with speech-language disorders, speech and language therapy is the standard of care for promoting recovery. However, barriers such as clinician time constraints and insurance reimbursement can inhibit a patient’s ability to receive the support needed to optimize functional gain. Although digital rehabilitation has the potential to increase access to therapy by allowing patients to practice at home, the clinical and demographic characteristics that impact a patient’s level of engagement with technology-based therapy are currently unknown. ObjectiveThis study aimed to evaluate whether the level of engagement with digital therapy differs by various patient characteristics, including age, gender, diagnosis, time from disease onset, and geographic location (urban vs rural). MethodsData for patients with stroke or TBI that initiated the use of Constant Therapy, a remotely delivered, cloud-based rehabilitation program for patients with speech-language disorders, were retrospectively analyzed. Only data from therapeutic sessions completed at home were included. The following three activity metrics were evaluated: (1) the number of active weeks of therapy, (2) the average number of active therapy days per week, and (3) the total number of therapeutic sessions completed during the first 20 weeks of program access. An active day or week was defined as having at least one completed therapeutic session. Separate multiple linear regression models were performed with each activity measure as the dependent variable and all available patient demographics as model covariates. ResultsData for 2850 patients with stroke or TBI were analyzed, with the average patient completing 8.6 weeks of therapy at a frequency of 1.5 days per week. Contrary to known barriers to technological adoption, older patients were more active during their first 20 weeks of program access, with those aged 51 to 70 years completing 5.01 more sessions than patients aged 50 years or younger (P=.04). Similarly, patients living in a rural area, who face greater barriers to clinic access, were more digitally engaged than their urban counterparts, with rural patients completing 11.54 more (P=.001) sessions during their first 20 weeks of access, after controlling for other model covariates. ConclusionsAn evaluation of real-world data demonstrated that patients with stroke and TBI use digital therapy frequently for cognitive and language rehabilitation at home. Usage was higher in areas with limited access to clinical services and was unaffected by typical barriers to technological adoption, such as age. These findings will help guide the direction of future research in digital rehabilitation therapy, including the impact of demographics on recovery outcomes and the design of large, randomized controlled trials.

Background: Evidence-based recommendations for a core outcome set (COS; minimum set of outcomes) for aphasia treatment research have been developed (the Research Outcome Measurement in Aphasia--ROMA, COS). Five recommended core outcome constructs: communication, language, quality of life, emotional well-being and patient-reported satisfaction/impact of treatment, were identified through three international consensus studies. Constructs were paired with outcome measurement instruments (OMIs) during an international consensus meeting (ROMA-1). Before the current study (ROMA-2), agreement had not been reached on OMIs for the constructs of communication or patient-reported satisfaction/impact of treatment. Aim: To establish consensus on a communication OMI for inclusion in the ROMA COS. Methods & Procedures: Research methods were based on recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. Participants with expertise in design and conduct of aphasia trials, measurement instrument development/testing and/or communication outcome measurement were recruited through an open call. Before the consensus meeting, participants agreed on a definition of communication, identified appropriate OMIs, extracted their measurement properties and established criteria for their quality assessment. During the consensus meeting they short-listed OMIs and participants without conflicts of interest voted on the two most highly ranked instruments. Consensus was defined a priori as agreement by [greater than or equal to] 70% of participants. Outcomes & Results: In total, 40 researchers from nine countries participated in ROMA-2 (including four facilitators and three-panel members who participated in pre-meeting activities only). A total of 20 OMIs were identified and evaluated. Eight short-listed communication measures were further evaluated for their measurement properties and ranked. Participants in the consensus meeting (n = 33) who did not have conflicts of interest (n = 29) voted on the top two ranked OMIs: The Scenario Test (TST) and the Communication Activities of Daily Living--3 (CADL-3). TST received 72% (n = 21) of 'yes' votes and the CADL-3 received 28% (n = 8) of 'yes' votes. Conclusions & Implications: Consensus was achieved that TST was the preferred communication OMI for inclusion in the ROMA COS. It is currently available in the original Dutch version and has been adapted into English, German and Greek. Further consideration must be given to the best way to measure communication in people with mild aphasia. Development of a patient-reported measure for satisfaction with/impact of treatment and multilingual versions of all OMIs of the COS is still required. Implementation of the ROMA COS would improve research outcome measurement and the quality, relevance, transparency, replicability and efficiency of aphasia treatment research.

Purpose: The impact of stimulus-level psycholinguistic variables and personlevel semantic and phonological processing skills on treatment outcomes in individuals with aphasia requires further examination to inform clinical decision making in treatment prescription and stimuli selection. This study investigated the influence of stimulus-level psycholinguistic properties and person-level semantic and phonological processing skills on word production accuracy and treatment response. Method: This retrospective analysis included 35 individuals with chronic, poststroke aphasia, 30 of whom completed typicality-based semantic feature treatment. Mixed-effects logistic regression models were used to predict binary naming accuracy (a) at baseline and (b) over the course of treatment using stimulus-level psycholinguistic word properties and person-level semantic and phonological processing skills as predictors. Results: In baseline naming, words with less complex lexical-semantic and phonological properties showed greater predicted accuracy. There was also an interaction at baseline between stimulus-level lexical-semantic properties and person-level semantic processing skills in predicting baseline naming accuracy. With treatment, words that were more complex from a lexical-semantic standpoint (vs. less complex) and less complex from a phonological standpoint (vs. more complex) improved more. Individuals with greater baseline semantic and phonological processing skills showed a greater treatment response. Conclusions: This study suggests that future clinical research and clinical work should consider semantic and phonological properties of words in selecting stimuli for semantically based treatment. Furthermore, future clinical research should continue to evaluate baseline individual semantic and phonological profiles as predictors of response to semantically based treatment.

Dementia is a common and debilitating condition that typically gives rise to increasing language impairment. There is a need to understand the nature of this impairment further so that therapies may be developed, particularly in the case of bilinguals. This paper extends BiLex, an existing computational model of bilingual lexical access, to simulate language decline in dementia. Six lesion types are evaluated for their ability to reproduce the pattern of decline in the semantic variant primary progressive aphasia (svPPA) subtype of dementia. Semantic memory lesions reproduce this pattern of decline best in monolinguals, and further suggest patterns that are likely to be found in longitudinal data from bilingual dementia patients in the future.

Purpose: The aim of this study was to assess the effect of an intensive cognitive and communication rehabilitation (ICCR) program on language and other cognitive performance in young adults with acquired brain injury (ABI). Method: Thirty young adults with chronic ABI participated in this study. Treatment participants (n = 22) attended ICCR 6 hours/day, 4 days/week for at least one 12-week semester. Deferred treatment/usual care control participants (n = 14) were evaluated before and after at least one 12-week semester. Pre- and post-semester standardized cognitive assessment items were assigned to subdomains. Between-groups and within-group generalized linear mixed-effects models assessed the effect of time point on overall item accuracy and differences by item subdomain. Subdomain analyses were adjusted for multiple comparisons. Results: Between-groups analyses revealed that treatment participants improved significantly faster over time than deferred treatment/usual care participants in overall item accuracy and specifically on items in the verbal expression subdomain. Investigating the three-way interaction between time point, group, and etiology revealed that the overall effects of the treatment were similar for individuals with nontraumatic and traumatic brain injuries. The treatment group showed an overall effect of treatment and significant gains over time in the verbal expression, written expression, memory, and problem solving subdomains. The control group did not significantly improve over time on overall item accuracy and showed significant subdomain-level gains in auditory comprehension, which did not survive correction. Conclusions: Sustaining an ABI in young adulthood can significantly disrupt key developmental milestones, such as attending college and launching a career. This study provides strong evidence that integrating impairment-based retraining of language and other cognitive skills with "real-world" application in academically focused activities promotes gains in underlying cognitive processes that are important for academic success as measured by standardized assessment items. These findings may prompt a revision to the current continuum of rehabilitative care for young adults with ABI.

Purpose: The impact of stimulus-level psycholinguistic variables and person-level semantic and phonological processing skills on treatment outcomes in individuals with aphasia requires further examination to inform clinical decision making in treatment prescription and stimuli selection. This study investigated the influence of stimulus-level psycholinguistic properties and person-level semantic and phonological processing skills on word production accuracy and treatment response. Method: This retrospective analysis included 35 individuals with chronic, post-stroke aphasia, 30 of whom completed typicality-based semantic feature treatment. Mixed-effects logistic regression models were used to predict binary naming accuracy (a) at baseline and (b) over the course of treatment using stimulus-level psycholinguistic word properties and person-level semantic and phonological processing skills as predictors. Results: In baseline naming, words with less complex lexical-semantic and phonological properties showed greater predicted accuracy. There was also an interaction at baseline between stimulus-level lexical-semantic properties and person-level semantic processing skills in predicting baseline naming accuracy. With treatment, words that were more complex from a lexical-semantic standpoint (vs. less complex) and less complex from a phonological standpoint (vs. more complex) improved more. Individuals with greater baseline semantic and phonological processing skills showed a greater treatment response. Conclusions: This study suggests that future clinical research and clinical work should consider semantic and phonological properties of words in selecting stimuli for semantically based treatment. Furthermore, future clinical research should continue to evaluate baseline individual semantic and phonological profiles as predictors of response to semantically based treatment. Supplemental Material: https://doi.org/10.23641/asha.21256341, Word production and treatment response in individuals with poststroke aphasia are influenced by treatment-level (e.g., dosage and stimuli; Brady et al., 2016) and person-level (i.e., demographic, behavioral, and neurological; Dali [...]

The present study examines the influence of language proficiency and language combination on bilingual lexical access using category fluency in 109 healthy speakers. Participants completed a category fluency task in each of their languages in three main categories (animals, clothing, and food), each with two subcategories, as well as a language use questionnaire assessing their proficiency. Five language combinations were examined (Hindi-English, Kannada-English, Mandarin-English, Spanish-English, and Turkish-English). Multivariate analyses of variance revealed that the average number of correct items named in the category fluency task across the three main categories varied across the different groups only in English and not the other language. Further, results showed that language exposure composite (extracted from the questionnaire using a principal component analysis) significantly affected the average number of items named across the three main categories. Overall, these results demonstrate the effects of particular language combinations on bilingual lexical access and provide important insights into the role of proficiency on access.

In everyday communication, speakers make errors and produce language in a noisy environment. Recent work suggests that comprehenders possess cognitive mechanisms for dealing with noise in the linguistic signal: a noisy-channel model. A key parameter of these models is the noise model: the comprehender's implicit model of how noise affects utterances before they are perceived. Here we examine this noise model in detail, asking whether comprehension behavior reflects a noise model that is adapted to context. We asked readers to correct sentences if they noticed errors, and manipulated context by including exposure sentences containing obvious deletions (A bystander was rescued by the fireman in the nick time.), insertions, exchanges, mixed errors, or no errors. On test sentences (The bat swung the player.), participants' corrections differed depending on the exposure condition. The results demonstrate that participants model specific types of errors and make inferences about the intentions of the speaker accordingly.

Purpose: The aim of this study was to assess the effect of an intensive cognitive and communication rehabilitation (ICCR) program on language and other cognitive performance in young adults with acquired brain injury (ABI). Method: Thirty young adults with chronic ABI participated in this study. Treatment participants (n = 22) attended ICCR 6 hours/day, 4 days/week for at least one 12-week semester. Deferred treatment/usual care control participants (n = 14) were evaluated before and after at least one 12-week semester. Pre- and postsemester standardized cognitive assessment items were assigned to subdomains. Between-groups and within-group generalized linear mixed-effects models assessed the effect of time point on overall item accuracy and differences by item subdomain. Subdomain analyses were adjusted for multiple comparisons. Results: Between-groups analyses revealed that treatment participants improved significantly faster over time than deferred treatment/usual care participants in overall item accuracy and specifically on items in the verbal expression subdomain. Investigating the three-way interaction between time point, group, and etiology revealed that the overall effects of the treatment were similar for individuals with nontraumatic and traumatic brain injuries. The treatment group showed an overall effect of treatment and significant gains over time in the verbal expression, written expression, memory, and problem solving subdomains. The control group did not significantly improve over time on overall item accuracy and showed significant subdomain-level gains in auditory comprehension, which did not survive correction. Conclusions: Sustaining an ABI in young adulthood can significantly disrupt key developmental milestones, such as attending college and launching a career. This study provides strong evidence that integrating impairment-based retraining of language and other cognitive skills with 'real-world' application in academically focused activities promotes gains in underlying cognitive processes that are important for academic success as measured by standardized assessment items. These findings may prompt a revision to the current continuum of rehabilitative care for young adults with ABI. Supplemental Material: https://doi.org/10.23641/asha.19320068, Acquired brain injury (ABI) encompasses a variety of etiologies, including traumatic brain injury (TBI), stroke, tumor, anoxic/hypoxic injury, and encephalitis among others. While sustaining an ABI at any age can [...]

Purpose: Despite a tremendous amount of research in this topic, the precise neural mechanisms underlying language recovery remain unclear. Much of the evidence suggests that activation of remaining left-hemisphere tissue, including perilesional areas, is linked to the best treatment outcomes, yet recruitment of the right hemisphere for various language tasks has also been linked to favorable behavioral outcomes. In this review article, we propose a framework of language recovery that incorporates a network-based view of the brain regions involved in recovery. Method: We review evidence from the extant literature and work from our own laboratory to identify findings consistent with our proposed framework and identify gaps in our current knowledge. Results: Expanding on Heiss and Thiel's (2006) hierarchy of language recovery, we identify 4 emerging themes: (a) Several bilateral regions constitute a network engaged in language recovery; (b) spared left-hemisphere regions are important components of the network engaged in language recovery; (c) as damage increases in the left hemisphere, activation expands to the right hemisphere and domain-general regions; and (d) patients with efficient, control-like network topology show greater improvement than patients with abnormal topology. We propose a mechanistic model of language recovery that accounts for individual differences in behavior, network topology, and treatment responsiveness. Conclusion: Continued work in this topic will lead us to a better understanding of the mechanisms underlying language recovery, biomarkers that influence recovery, and, consequently, more personalized treatment options for individual patients.

How do cognitive processes influence speaking? We used a novel variant of the Stroop test to measure whether cognitiveinhibition could modulate acoustic properties of speech. Participants named the color of words in three categories: 1)congruent (e.g. red written in red), 2) color-incongruent (e.g. green written in red), and 3) vowel-incongruent, withphonetic properties that partially matched the text color (e.g. rid written in red). We hypothesized that the cognitive effortof inhibiting reading in this third conditionsaying red, not ridcould affect the acoustics of the spoken response. A classicStroop effect was evident: congruent trials were faster than color-incongruent trials. Interestingly, vowel-incongruent trialsdid not show this reaction time difference, but spoken vowels from these trials were systematically biased away from thevisually-presented text. Thus, the inhibition of a competing target is manifest in an accentuation of the acoustic contrastbetween the spoken and inhibited words.

Purpose: Cumulative Intervention Intensity (CII) is a proposed framework for conceptualizing and calculating dose that has been used to quantify intensity of speech-language therapy (SLT) in highly controlled laboratory studies and clinical trials. However, it is unknown whether CII can be applied to characterize the practice patterns of patients undertaking at-home, self-managed SLT. The current study leverages real-world mobile health data to investigate the applicability of CII parameters to self-managed SLT, including the interrelationships between individual CII parameters and their utility for identifying naturally occurring subgroups of patient users. Method: Anonymized data from 2,223 poststroke survivors who used the Constant Therapy application were analyzed. Four quantitative CII parameters—dose, session frequency, session duration, and total intervention duration—were calculated per user over a 3-month analysis period using raw session-level data. We conducted correlation analyses at the level of the individual and group to examine the degree of relatedness between each of the CII parameters. CII parameter measures were additionally used as inputs to a k-mean clustering analysis to identify practice pattern subgroups. Results: Results demonstrate the feasibility of calculating components of CII based on available usage statistics from a commercial app for self-managed SLT. Specifically, results suggest that, although CII parameters are related, session frequency offers complementary and nonoverlapping information (cf. dose, session duration, total intervention duration) about dosage. Clustering results show that practice patterns can be broadly differentiated according to the (a) amount and (b) frequency of practice. Conclusions: The calculation of CII may provide both users and clinicians with a fuller picture of at-home, self-managed practice habits than looking at any one dosage component alone. The study represents a first step toward more comprehensive and theoretically grounded dose reporting for self-managed SLT. [ABSTRACT FROM AUTHOR]

Purpose: Despite a tremendous amount of research in this topic, the precise neural mechanisms underlying language recovery remain unclear. Much of the evidence suggests that activation of remaining left-hemisphere tissue, including perilesional areas, is linked to the best treatment outcomes, yet recruitment of the right hemisphere for various language tasks has also been linked to favorable behavioral outcomes. In this review article, we propose a framework of language recovery that incorporates a network-based view of the brain regions involved in recovery. Method: We review evidence from the extant literature and work from our own laboratory to identify findings consistent with our proposed framework and identify gaps in our current knowledge. Results: Expanding on Heiss and Thiel's (2006) hierarchy of language recovery, we identify 4 emerging themes: (a) Several bilateral regions constitute a network engaged in language recovery; (b) spared left-hemisphere regions are important components of the network engaged in language recovery; (c) as damage increases in the left hemisphere, activation expands to the right hemisphere and domain-general regions; and (d) patients with efficient, control-like network topology show greater improvement than patients with abnormal topology. We propose a mechanistic model of language recovery that accounts for individual differences in behavior, network topology, and treatment responsiveness. Conclusion: Continued work in this topic will lead us to a better understanding of the mechanisms underlying language recovery, biomarkers that influence recovery, and, consequently, more personalized treatment options for individual patients. Presentation Video: https://doi.org/10.23641/asha.10257590, Understanding the nature of language recovery in aphasia is one of the fundamental and momentous questions in aphasia research as it impacts the diagnosis, treatment, and prognosis of patients with [...]

Semantic feature-based treatments (SFTs) are effective rehabilitation strategies for word retrieval deficits in bilinguals with aphasia (BWA). However, few studies have prospectively evaluated the effects of key parameters of these interventions on treatment outcomes. This study examined the influence of intervention-level (i.e., treatment language and treatment sessions), individual-level (baseline naming severity and age), and stimulus-level (i.e., lexical frequency, phonological length, and phonological neighborhood density) factors on naming improvement in a treated and untreated language for 34 Spanish–English BWA who completed 40 hours of SFT. Results revealed significant improvement over time in both languages. In the treated language, individuals who received therapy in their L1 improved more. Additionally, higher pre-treatment naming scores predicted greater response to treatment. Finally, a frequency effect on baseline naming accuracy and phonological effects on accuracy over time were associated with differential treatment gains. These findings indicate that multilevel factors are influential predictors of bilingual treatment outcomes. [ABSTRACT FROM AUTHOR]

Previous studies on bilingualism and aphasia have identified a similar pattern of verb-noun dissociation in single-word naming (i.e., lower accuracy for verbs than nouns) in both languages. However, whether a similar pattern of verb and noun dissociation emerges in discourse production remains unknown, particularly in typologically dissimilar languages. This study investigated patterns of verb and noun impairment in both single-word naming and discourse production, and whether naming was associated with lexical retrieval in discourse production in Mandarin-English bilingual adults with aphasia (BWA). Twelve Mandarin-English bilinguals with chronic aphasia completed standardized assessments on object and action naming, and three discourse tasks from the AphasiaBank (i.e., sequential pictures, single-picture, storytelling) in both L1 (Mandarin) and L2 (English). Item-level accuracy of object and action naming was fit into a generalized mixed-effects model to estimate single-word naming ability as a function of grammatical category. The proportion of verb and noun production and the number of verbs and nouns per utterance were fit into multivariate linear regression models to assess lexical retrieval in discourse. Finally, another linear regression was performed to examine the association between naming and lexical retrieval in discourse production. The naming accuracy for verbs was lower than for nouns in both L1 and L2. Mandarin-English BWA also demonstrated less production of verbs than nouns in discourse. However, depending on the type of the task, the effect of word category was greater in L2 than in L1. This cross-linguistic difference of the verb-noun dissociation was diminished in individuals with lower aphasia severity. Our results further showed a direct relationship between naming and lexical retrieval in discourse, irrespective of the language. Our findings suggest an overall similar pattern of verb and noun dissociation across different linguistic contexts. However, depending on the cognitive-linguistic demands of the task, the verb-noun dissociation may emerge in L1 and L2 to varying degrees in individuals with different levels of aphasia severity. This study facilitates better understanding of verb and noun retrieval in Mandarin-English BWA. [ABSTRACT FROM AUTHOR]