ABSTRACT Background While many measures exist for assessing discourse in aphasia, manual transcription, editing, and scoring are prohibitively labor intensive, a major obstacle to their widespread use by clinicians (Bryant et al. 2017; Cruice et al. 2020). Many tools also lack rigorous psychometric evidence of reliability and validity (Azios et al. 2022; Carragher et al. 2023). Establishing test reliability is the first step in our long-term goal of automating the Brief Assessment of Transactional Success in aphasia (BATS; Kurland et al. 2021) and making it accessible to clinicians and clinical researchers. Aims We evaluated multiple aspects of test reliability of the BATS by examining correlations between human/machine and human/human interrater edited transcripts, raw vs. edited transcripts, interrater scoring of main concepts, and test-retest performance. We hypothesized that automated methods of transcription and discourse analysis would demonstrate sufficient reliability to move forward with test development. Methods & Procedures We examined 576 story retelling narratives from a sample of 24 persons with aphasia and familiar and unfamiliar conversation partners (CP). Participants with aphasia (PWA) retold stories immediately after watching/listening to short video/audio clips. CP retold stories after six-minute topic-constrained conversations with a PWA in which the dyad co-constructed the stories. We utilized two macrostructural measures to analyze the automated speech-to-text transcripts of story retells: 1) a modified version of a semi-automated tool for measuring main concepts (mainConcept: Cavanaugh et al. 2021); and 2) an automated natural language processing “pipeline” to assess topic similarity. Outcomes & Results Correlations between raw and edited scores were excellent, interrater reliability on transcripts and main concept scoring were acceptable. Test-retest on repeated stimuli was acceptable. This was especially true of aphasic story retellings where there were actual within subject repeated stimuli. Conclusions Results suggest that automated speech-to-text was generally sufficient in most cases to avoid the time-consuming, labor intensive step of transcribing and editing discourse. Overall, our study results suggest that natural language processing automated methods such as text vectorization and cosine similarity are a fast, efficient way to obtain a measure of topic similarity between two discourse samples. Although test-retest reliability for the semi-automated mainConcept method was generally higher than for automated methods of measuring topic similarity, we found no evidence of a difference between machine automated and human-reliant scoring.

ABSTRACT Background Persons with nonfluent aphasia (PWNA) have deficits with online feedback for speech error detection and correction which have debilitating effects on language relearning in learned and novel contexts. Previous studies have shown that aphasia treatments that combine PWNA’s offline self-feedback and external feedback from speech-language pathologists (SLPs) improve language production in learned and novel contexts. However, it remains unclear whether PWNA can use their offline self-feedback alone during treatments that generalizes to improvement in connected speech production. Here, we examine generalization effects of recursive self-feedback on PWNA’s connected speech production. Recursive self-feedback utilizes offline self-feedback loops alone to help PWNA optimize their error monitoring and correction abilities for language production in learned and novel contexts. Method A crossover design was used to investigate generalization effects of two treatments on connected speech production in four PWNA. These treatments comprised script production with recursive self-feedback and script production with external feedback. Employing a mobile health approach, treatments were remotely administered to participants within the comfort of their homes. Practice of both treatment blocks occurred intensively over two hours per day, five days per week, spanning two to three weeks. Each treatment block featured pretreatment and posttreatment assessment phases, with the sequencing of treatment blocks evenly counterbalanced across all participants. Following the initial treatment block, a two-week period devoid of treatment preceded the commencement of the second treatment block. Untrained narrative elicitation tasks were utilized to prompt connected speech production samples from all participants during the assessment phases of each treatment block. Effect sizes per participant were computed using within-case standard mean difference analysis. Results PWNA exhibited variability in performance, showing improvement in microlinguistic measures of connected speech following both script production with recursive self-feedback and script production with external feedback. Particularly, script production with recursive self-feedback demonstrated marginally superior enhancement in connected speech measures compared to its counterpart. Conclusion The study provides preliminary evidence for generalization effects of recursive self-feedback training and external feedback training on PWNA’s connected speech production. Further research is required to corroborate the findings and to implement recursive self-feedback procedures optimized specifically for spontaneous speech.

ABSTRACT Background Maintaining quality of life (QoL) and identifying contributing factors is an important aspect of treatment for glioma patients. Little is known about to what extent language function and psychological distress impact QoL before surgery. Aims The aim of the present study was to investigate the impact of subjective and objective language function, as well as psychological distress on domains of QoL before surgery. Methods and procedures Twenty-seven patients (52% female) with a suspected glioma, grade 1‒3 based on symptoms and MRI imaging diagnostics were assessed pre-surgery. Subjective language concerns, psychological distress and QoL were investigated with self-reported questionnaires. A Subjective language index was calculated, based on items addressing word-finding, expression of thoughts, reading and writing. Objective language function was assessed with tasks of naming (The Boston Naming Test), verbal comprehension (Vocabulary and Similarities), verbal fluency (Semantic and Phonemic fluency) and verbal short-term and working memory (Digit span forward and backward). The strength of associations was determined using Spearman’s rho correlations. Linear regression analyses were used to examine predictors for QoL. Outcomes and Results Clinically significant reductions in QoL were found in 48% of the sample. Subjective language concerns were highly common, with 85% reporting some degree of difficulty. Group means on objective language tests were within normative range on the included measures. The Subjective language index correlated significantly with several QoL domains, whereas objective performance mainly correlated with functional well-being. Psychological distress was a strong predictor for QoL. Conclusions The findings demonstrate that reductions in QoL may occur during the diagnostic phase, even before glioma treatment starts. Subjective language concerns and psychological distress contributed to all aspects of QoL and highlight the importance of acknowledging patient-reported information. The results suggest a comprehensive multi-modal assessment of glioma patients pre-surgery, to establish a base-line and facilitate patient-centered treatment planning.

ABSTRACT Background Tissue plasminogen activator (tPA) is a common therapeutic agent approved to treat patients with stroke. When the agent is administered within 4.5 hours of stroke onset, tPA administration helps to restore blood flow to brain regions affected by a stroke, thereby limiting the risk of damage and functional impairment. However, research evaluating the use of tPA on aphasia – loss of the ability to understand or express speech – a common post-stroke condition is limited. A meta-analysis of available evidence was performed to assess the association between the use of tPA on aphasia post-stroke. Methods A literature search was performed using the PubMed, Web of Science, and SCOPUS electronic database using keywords “tPA”, “tissue plasminogen activator”, “aphasia”, and “stroke” published in English since 2010. An initial search revealed 7, 069, 6,682, and 289 studies in PubMed, Web of Science, and SCOPUS, respectively. Studies without a measure of aphasia impairment in adults as well as case studies and reviews were excluded. After quality assessment and a review of study abstracts, 14 relevant studies were identified for full text review. Among the 14, ten were deemed appropriate for inclusion and feature extraction. Results Associations between tPA and aphasia outcomes in each of the included studies were translated to odds ratios (ORs) and study features were coded for inclusion in a random effects meta regression. Results revealed a statistically significantly higher likelihood of improvement in the level of post-stroke aphasia among those receiving tPA compared with those not receiving tPA (odds ratio [OR], 2.1963, CI = 0.5994, 3.7932). Model statistics did however indicate substantial heterogeneity (I2 = 96.94%, Ƭ2 = 32.65) between studies. After removal of two outliers from the analysis set, the estimates improved substantially (OR = 1.8643, CI = 1.2131, 2.5155), and heterogeneity was reduced (I2 = 76.28%, Ƭ2 = 4.22). Estimates were robust to the inclusion of study location, metric used to measure aphasia, observed recovery duration, and size of the sample. Conclusion This meta-analysis found an increased likelihood of aphasia recovery in patients receiving tPA following stroke and significant improvement in communication from tPA receipt. However, further prospective studies with greater sample heterogeneity are needed to determine the appropriate window for tPA use, the duration of improvement, and the long-term effects on communication outcomes.

ABSTRACT Background Forced switching between languages poses demands on control abilities, which may be difficult to meet for bilinguals with aphasia. Freely choosing languages has been shown to increase naming efficiency in healthy bilinguals, and lexical accessibility was found to be a predictor for language choice. The overlap between bilingual language switching and other types of switching is yet unclear. Aims This study aimed to examine the benefits of free language choice for bilinguals with aphasia and to investigate the overlap of between- and within-language switching abilities. Methods & Procedures Seventeen bilinguals with aphasia completed a questionnaire and four web-based picture naming tasks: single-language naming in the first and second language separately; voluntary switching between languages; cued and predictable switching between languages; cued and predictable switching between phrase types in the first language. Accuracy and naming latencies were analysed using (generalised) linear mixed-effects models. Outcomes & Results The results showed higher accuracy and faster naming for the voluntary switching condition compared to single-language naming and cued switching. Both voluntary and cued language switching yielded switch costs, and voluntary switch costs were larger. Ease of lexical access was a reliable predictor for voluntary language choice. We obtained no statistical evidence for differences or associations between switch costs in between- and within-language switching. Conclusions Several results point to benefits of voluntary language switching for bilinguals with aphasia. Freely mixing languages improved naming accuracy and speed, and ease of lexical access affected language choice. There was no statistical evidence for overlap of between- and within-language switching abilities. This study highlights the benefits of free language choice for bilinguals with aphasia.

ABSTRACT Background Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by progressive language deficits. The main variants of PPA – semantic (svPPA), logopenic (lvPPA), and nonfluent (nfvPPA) – can be challenging to distinguish. Limb apraxia often co-occurs with PPA, but it is unclear whether PPA variants are associated with different gesture deficits. Prior evidence from stroke indicates that temporal lobe lesions are associated with reduced benefit from meaning in gesture performance. Temporal lesions are also associated with greater deficits in hand postures compared to arm kinematics in gesture imitation. Aims We tested the hypothesis that svPPA, who primarily exhibit temporal lobe atrophy, would differentially show this pattern. In addition, we predicted that as a group, individuals with PPA would more accurately produce meaningful than meaningless gestures and kinematic components than hand postures, as found in neurotypical adults and individuals with stroke. Methods & Procedures Participants with PPA completed meaningful and meaningless gesture imitation tasks. Performance was scored for hand posture and arm kinematic components. Bayesian mixed-effect models examined trial-level gesture imitation accuracy, while controlling for dementia severity and random effects of subjects and items. Fixed effects included an interaction between PPA variant, task condition/meaning, and gesture component. Outcomes & Results We found a critical interaction between PPA variant, meaning, and gesture component. In particular, unlike lvPPA and nfvPPA, svPPA subjects’ hand postures failed to benefit from gesture meaning. This preliminary research extends prior findings on the role of the temporal lobe in action representations associated with manipulable objects, and is among the first to demonstrate distinct gesture imitation patterns between PPA variants. Conclusions Characterizing gesture deficits in PPA may help inform diagnostics, compensatory communication strategies, and models of praxis.

ABSTRACT Active collaboration between speech-language therapists (SLTs) and persons with aphasia (PWA) is essential for personalizing aphasia treatment and optimizing clinical outcomes during aphasia rehabilitation. Studies have demonstrated the feasibility and effectiveness of collaboration between SLTs and PWA during the goal setting component of the intervention process in aphasia rehabilitation. However, it remains unclear whether this collaboration as well as PWA’s feedback can be applied and be beneficial to all components of aphasia rehabilitation. Here we introduce a theoretical framework of self-regulated learning (SRL) for aphasia rehabilitation that spotlights the role of PWA’s feedback in all components of the rehabilitation process. We review studies on models of SRL in educational psychology and evidence from clinical aphasiology and neurolinguistics. Based on the evidence, we argue that PWA’s feedback is beneficial for optimizing all components of the intervention process in aphasia rehabilitation. To make this work, communicative barriers to collaborative, patient-centered goal setting must be minimized or eliminated to facilitate alternative channels for receiving PWA’s feedback which will promote their engagement in aphasia rehabilitation. Also, insights from PWA’s feedback can help SLTs to select treatments and tasks that promote PWA’s engagement in the intervention process, which, in turn, can maximize aphasia recovery and increase quality of life. PWA can be active participants in the whole intervention process and SLTs can use information from PWA’s feedback to improve the personalization of the complete intervention process to maximize clinical outcomes.

ABSTRACT Background The Intensive Comprehensive Aphasia Program (ICAP) is a rehabilitation service delivery model initially articulated in a seminal article featured in the 2013 Special Issue of Topics in Stroke Rehabilitation. Over the past decade, the ICAP model has experienced a notable surge in prominence, leading to a burgeoning research base and worldwide implementation in clinical practice. Aim This special issue serves as a comprehensive exploration of how the theoretical underpinnings of the ICAP components manifest in contemporary practice by presenting recent outcomes from active clinical ICAPs. The primary objective of this introduction is to establish a contextual framework for the articles comprising this special issue. Main Contribution The introduction delineates the fundamental components of the ICAP model, offering succinct summaries of the relevant literature that catalyzed the conceptualization of these components by Rose and colleagues. Conclusions This introduction along with the collective works within this issue, positions the ICAP model within the broader aphasia rehabilitation continuum of care. Furthermore, it serves as a pivotal starting point for shaping the ICAP research agenda for the next decade. Specific expansions to the evidence are imperative, including single-site and multi-site randomized controlled trials featuring consistent outcome measures that include discourse measures and follow-up data points, investigations into cost-effectiveness and sustainability, and systematic examinations of the active ingredients of therapeutic elements within the model.

ABSTRACT Background Intensive Comprehensive Aphasia Programs (ICAPs) provide high doses of treatment over short periods. Treatment intensity in post-stroke aphasia rehabilitation and research is not well understood and is typically underspecified, including within ICAPs and modified Intensive Comprehensive Aphasia Programs (mICAPs), in which intensity is a fundamental design component. One recently developed model of treatment conceptualisation, the Multidimensional Dose Articulation Framework (MDAF), may offer a systematic, comprehensive, and granular method of characterising treatment intensity, though this framework has not yet been used to capture elements of intensity and dose during an ICAP or mICAP. Aims The purpose of this paper is to examine and describe increasingly specific details of treatment intensity for both an ICAP and mICAP delivered at the University of Montana (UMT). Methods & Procedures Fourteen participants with aphasia attended an 84-hour ICAP (n = 8) or a 24-hour mICAP (n = 6) delivered by graduate student clinicians at UMT. Ethics approval was obtained from the UMT IRB (#13-23). We examined intensity and dose using components of the MDAF including broad temporal parameters, and episode-specific length and intensity. Descriptive statistics were used to report group-level, participant-level, and treatment-level parameters. Outcomes & Results In this descriptive manuscript, we use a series of vignettes to report temporal parameters from the MDAF including treatment duration, days, sessions, and session density, and episode-level characteristics including episode length and episode intensity. Vignette one examines ICAP and mICAP planned versus actual temporal parameters. Vignette two describes episode-level detail across two evidence-based treatments administered during the ICAP. Vignette three details differences in delivery of a single treatment approach between two participants. In each vignette, we discuss the benefits and challenges of tracking treatment intensity with fine detail. Conclusions Comprehensive specification of dose and intensity parameters is essential to compare efficacious treatment programs and to understand variability in treatment response across individuals with aphasia. The MDAF is a promising tool, though detailed treatment intensity remains a challenging construct to measure, particularly at the level of the episode. Clinical researchers interested in dose and intensity and authors of evidence-based therapy approaches must continue to work to define and describe active ingredients within therapy approaches.

ABSTRACT Background Agrammatic aphasia poses challenges in assessing grammatical abilities due to language comprehension difficulties. The suitability of sMMN as an indicator of syntactic processing abilities in these individuals remains uncertain. Aims Two ERP experiments were conducted to investigate whether early syntactic mismatch negativity (sMMN) could assess the syntactic processing ability of Chinese-speaking individuals with agrammatic aphasia. Methods & Procedures Prior to the ERP experiments, the Western Aphasia Battery (WAB) and the Northwestern Assessment of Verbs and Sentences-Chinese (NAVS-C) were used to screen people with agrammatism. ERP data were collected for both the agrammatic group (AG) (n = 12) and the control group (CG) (n = 12). The first experiment (Experiment 1) involved a passive tone oddball task to control for the influence of primary sound perception. The second experiment (Experiment 2: experiment 2a and experiment 2b) investigated syntactic processing through a passive speech oddball task. Experiment 2a examined the processing of correct sentences and syntactic violation sentences in context. In contrast, Experiment 2b assessed well-formed sequences and ill-formed sequences out of context. Outcomes & Results The results revealed that frontocentral distributed acoustic MMNs were recorded for the CG between 176 - 196ms in Experiment 1, but not for the AG. In Experiment 2, during the 143 - 173ms window, the left anterior sMMN was exclusively observed for the CG, while the left posterior sMMN was specific to the AG. Furthermore, the amplitudes of the left posterior sMMN (143-173ms) were found to have a negative correlation with scores on sentence comprehension tests: the more negative the sMMN, the lower the scores of people with agrammatic aphasia. Notably, this left posterior MMN was absent in Experiment 1. Conclusions The early posterior sMMN, discovered for the first time in our study, appears to be more sensitive in detecting syntactic processing impairments in agrammatics compared to the early anterior sMMN. This finding has the potential to enhance the precision of aphasia assessment.