Tyson Harmon

BackgroundPeople with aphasia often experience activity limitations and participation restrictions despite wanting to engage in communication activities that are satisfying and meaningful. Communication partner support, the complexity of the communication environment, and the thoughts and feelings of people with aphasia have important implications for both language processing and communicative participation. The perspectives of PWA about the role that environmental and personal factors (e.g. thoughts and feelings) play in their communication experiences could inform clinical practice.<br>AimsTo qualitatively explore the communication experiences of people with aphasia and how environmental demands and personal factors (especially emotional responses) affect these experiences.<br>Methods & ProceduresFourteen participants with aphasia completed semi-structured interviews immediately following testing sessions for a larger mixed-methods project investigating the relationship between mood, attention, and language function. Interview questions related to their everyday communication experiences and how their communication environment affected their communication and concentration as well as how their emotions affected their communication. Interviews were recorded, transcribed orthographically, then analyzed using a generic qualitative descriptive approach. Coding was completed in two rounds, which included inductive and deductive coding. Codes were synthesized by reflexively analyzing code co-occurrence.<br>Outcomes & ResultsKey antecedent variables included language deficits associated with aphasia and environmental demands, often leading to communication challenges. Participation was highlighted as the principal outcome, ranging from proactive engagement to withdrawal. Mental rehearsal, feelings, and attitudes mediated participation, but feelings and attitudes were also described as outcomes. Communication partners played a pivotal mediating role, often determining positive or negative outcomes. Supportive partners facilitated engagement, optimism, and contentment, while unsupportive partners led to frustration.<br>ConclusionsThe results of this study highlight the role of various factors in influencing the communication experience of people with aphasia and indicate that, within the context of communication challenges, communication partners, attitudes, feelings, and participation play critical and interacting roles. Preparatory strategies such as mental rehearsal can also facilitate participation. These findings imply that targeting communication partner support, mental rehearsal focused on social scripts, or psychosocial adjustment could have important effects on participation.

<b>Background:</b> Most everyday communication occurs in situations where cognitive and social demands are present. These types of situations may compound language deficits for people with aphasia (PWA). An understanding of the language interference that may occur from cognitive and social demands is an important precursor for assessment and intervention that addresses everyday communication situations.<br><b>Aims:</b> To determine how cognitively and socially demanding con-ditions affect micro- and macrolinguistic production for people with moderate, mild, or no aphasia during narrative discourse and to compare effects among groups.<br><b>Method:</b> Thirty participants with mild (n = 9), moderate (n = 9), or no (n = 12) aphasia completed story-retell tasks in three separate conditions: baseline, unresponsive partner, and dual-task. The stor-ies and conditions were pseudorandomly presented for each parti-cipant. A secondary analysis investigated lexical, morphosyntactic, and macrolinguistic production.<br><b>Results:</b> As expected, when compared with baseline, the dual-task condition interfered more with language production than the unre-sponsive partner condition for all participant groups. Interference on distinct aspects of language production for each participant group, however, was not anticipated. This interference was char-acterized by significant dual-task costs on (a) macrolinguistic pro-duction for participants with moderate aphasia, (b) word productivity and lexical diversity for participants with mild aphasia, and (c) lexical-phonological errors for participants with no aphasia. When compared with baseline, the unresponsive partner led to numerical interference on the same measure and group combina-tions as the dual-task, but these changes were not statistically significant.<br><b>Conclusions:</b> Cognitive and social demands have different effects on language depending on the presence and severity of aphasia with cognitive demands impacting discourse-level structures for participants with moderate aphasia, lexical-level structures for par-ticipants with mild aphasia, and lexical-phonological errors for participants with no aphasia. Future research should identify how these demands could be integrated with assessment and treatment for PWA to help improve everyday communication participation.

<b>Purpose: </b>The purpose of this study was to determine how different background noise conditions affect the spoken language of participants with aphasia during a story retell task.<br><b>Method: </b>Participants included 11 adults with mild to moderate aphasia and 11 age- and gender-matched controls. Participants retold stories in a silent baseline and five background noise conditions (conversation, monologue, phone call, cocktail, and pink noise). Dependent measures of speech acoustics (fundamental frequency and mean intensity), speech fluency (speech rate and disfluent words), and language production (correct information units [CIUs], lexical errors, lexical diversity, and cohesive utterances) were compared between groups and across conditions.<br><b>Results: </b>Background noise resulted in higher fundamental frequency (<i>f</i>_o) and increased mean intensity for control participants across all noise conditions but only across some conditions for participants with aphasia. In relation to language production, background noise interfered significantly more with communication efficiency (i.e., percent CIUs) for participants with aphasia than the control group. For participants with aphasia, the phone call condition led to decreased lexical diversity. Across groups, condition effects generally suggested more interference on speech acoustics in conditions where continuous noise was present and more interference on language in conditions that presented continuous informational noise.<br><b>Conclusions:</b> Although additional research is needed, preliminary findings suggest that background noise interferes with narrative discourse more for people with aphasia (PWA) than neurologically healthy adults. PWA may benefit from therapy that directly addresses communicating in noise.

<b>Purpose:</b> This study aimed to (a) compare physiological arousal and attentiveness during a confrontational naming task between participants with aphasia and a control group across four conditions that varied according to emotionality of presented stimuli and (b) explore relationships among physiological arousal, attentiveness, perceived arousal, and naming performance. We hypothesized that participants with aphasia would show lower levels of arousal and attentiveness than control participants and that emotional conditions would lead to increased physiological arousal and attentiveness.<br><b>Method:</b> Eight participants with aphasia and 15 control participants completed a confrontational naming task under positive, negative, and neutral conditions and rated their perceived arousal after each. Electrophysiological recordings were taken during the entire experiment to obtain measures of heart rate (HR), HR variability, and skin conductance (SC). Videos of confrontational naming trials were rated based on visual signs of participant attentiveness during each trial.<br><b>Results: </b>Statistically significant group differences were found for HR, SC, and attentiveness ratings, but no differences were found in these measures among conditions. Correlational analyses revealed statistically significant relationships between attentiveness and response time, HR, and naming accuracy. Significant correlations were also found for HR and naming accuracy as well as perceived arousal and naming accuracy.<br><b>Conclusions:</b> Findings suggest that decreased physiological arousal or attentiveness may contribute to naming deficits for people with aphasia (PWA). Assisting PWA to fully attend to and engage in therapy tasks may be important for accurate assessment of language functions and for achieving optimal benefit in treatment.

Emotion plays an integral role in communication and has long<br>been considered relevant to aphasia rehabilitation. Speech-language<br>pathologists (SLPs), however, may sometimes wonder how or whether<br>to address emotional responses. The purpose of this article was to (1)<br>present a framework that clinicians can use to understand individualized<br>emotional responses in aphasia and (2) discuss examples of how the<br>framework informs practical strategies that SLPs can use to provide<br>emotional support to people with aphasia (PWA). Drawing upon a<br>cognitivemotivationalrelational theory of emotions perspective combined with emerging research in aphasia, I show that emotion impacts<br>and is impacted by both language processing and social participation,<br>but this impact should be interpreted in light of individual variability.<br>Personal characteristics, environmental conditions, and cognitive<br>appraisal, considered within a specific cultural context, help account<br>for individualized emotional responses. SLPs should consider interactions among emotional response, language processing, and social<br>participation in aphasia while recognizing each persons unique perception of the situation and resources to cope with it. Additionally, the<br>presented framework provides insights about how SLPs could offer<br>emotional support to PWA. Specific examples related to harnessing<br>situational demands to improve communication, employing active<br>listening, facilitating reappraisal, and strengthening social support are<br>discussed.

<b>Background. </b>Communication partner training (CPT) involves educating conversation partners to implement communication strategies that facilitate improved interactions with people with aphasia (PWA). This study aimed to<b> </b>investigate<b> </b>(1) whether a CPT program increased the knowledge and confidence of students with and without a communication disorders background and (2) the differential effects of this training on students from different allied health disciplines.<br><b>Methods. </b>Quasi-experimental design study with 6 adult volunteers with aphasia and 36 students (18 SLP students and 18 PT/OT students). The CPT program was provided twice (in 2015 and 2016) as a single seminar at an American university.<br><b>Results. </b>All students reported increased confidence in communicating with PWA and were able to identify a greater number of appropriate communication strategies after the CPT than they could identify before the training. The SLP students demonstrated greater aphasia knowledge than the PT/OT students prior to training; only the PT/OT students reported increased knowledge about aphasia after training.<br><b>Discussion. </b>Involvement of PWA in CPT programs may be particularly important in enabling students to develop confidence in communicating with PWA. Practice opportunities with PWA can be provided as early as the beginning of didactic coursework through an interdisciplinary CPT program.

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.<br>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.<br>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.<br>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.

<b>Purpose:</b> To investigate how emotional arousal and valence affect confrontational naming accuracy and response time in people with mild to moderate aphasia compared with adults without aphasia. We hypothesized that negative and positive emotions would facilitate naming for people with aphasia but lead to slower responses for adults with no aphasia.<br><b>Method:</b> Eight participants with mild to moderate aphasia, 15 older adults, and 17 young adults completed a confrontational naming task across three conditions (positive, negative, neutral) in an ABA case series design. Immediately following each naming condition, participants self-reported their perceived arousal and pleasure. Accuracy and response time were measured and compared.<br><b>Results: </b>As expected, people with aphasia performed significantly less accurately and with longer response times than both young and older adult groups across all conditions. However, opposite our hypothesis for the aphasia group, the negative condition resulted in decreased accuracy for the aphasia as well as the older adult group and increased response time across all groups. No statistically significant differences were found between the positive and any other condition. Participants with aphasia who demonstrated an effect in the negative condition were observed to produce a larger proportion of semantically related errors than any other error types.<br><b>Conclusions: </b>Findings suggest that strong negative emotions can interfere with semantic-lexical processing by diverting attentional resources to emotion regulation. Both clinicians and researchers should be aware of the potential influence of negative stimuli and negative emotional states on language performance for people with aphasia and these effects should be disentangled in future research. Further research should also be conducted with a larger number of participants with aphasia across a broader range of severity to replicate and extend findings.

<b>Purpose:</b> The aim of this study was to investigate how different types of background noise that differ in their level of linguistic content affect speech acoustics, speech fluency, and language production for young adult speakers when performing a monologue discourse task.<br><b>Method:</b> Forty young adults monologued by responding to open-ended questions in a silent baseline and five background noise conditions (debate, movie dialogue, contemporary music, classical music, and pink noise). Measures related to speech acoustics (intensity and frequency), speech fluency (speech rate, pausing, and disfluencies), and language production (lexical, morphosyntactic, and macrolinguistic structure) were analyzed and compared across conditions. Participants also reported on which conditions they perceived as more distracting.<br><b>Results:</b> All noise conditions resulted in some change to spoken language compared with the silent baseline. Effects on speech acoustics were consistent with expected changes due to the Lombard effect (e.g., increased intensity and fundamental frequency). Effects on speech fluency showed decreased pausing and increased disfluencies. Several background noise conditions also seemed to interfere with language production.<br><b>Conclusions:</b> Findings suggest that young adults present with both compensatory and interference effects when speaking in noise. Several adjustments may facilitate intelligibility when noise is present and help both speaker and listener maintain attention on the production. Other adjustments provide evidence that background noise eliciting linguistic interference has the potential to degrade spoken language even for healthy young adults, because of increased cognitive demands.

<b>Background</b>: Everyday communication often occurs in situations that pose high attentional and social demands. People with aphasia have reported perceiving greater challenge communicating in these situations, but more specific information about these challenges could help clinicians and researchers work toward more meaningful intervention outcomes and increased life participation.<br><b>Aims</b>: To explore the everyday communication experiences of people with aphasia based on their own perspectives and to identify how they report coping with everyday communication challenges.<br><b>Method</b>: Twenty-one participants with mild or moderate aphasia completed semi-structured interviews that immediately followed the experimental arm of a larger project. Interview questions solicited descriptions and examples of communication experiences from participants everyday life that related to the situations they experienced during the experiment (retelling stories to responsive and unresponsive communication partners and while completing a concurrent tone discrimination task). Interviews were recorded, transcribed orthographically, then coded using thematic analysis.<br><b>Results</b>: Qualitative analysis revealed two themes related to participants communication experiences (i.e., relationships, environmental distractions) and one theme relating to their reactions to challenging everyday communication experiences (i.e., coping). They perceived that they were influenced by their communication partners and the physical environment in which communication took place. Two thirds of participants described implementing behavioral and/or cognitive strategies to cope with everyday communication challenges.<br><b>Conclusions</b>: Everyday communication is often challenging for people with aphasia when they feel unsupported by communication partners (even close family members and friends), are exposed to background noise, or are performing a concurrent task. One way that participants coped with challenging communication situations was to regulate their thoughts, attitudes, or beliefs. Future research is needed to understand how to appropriately focus on cognitive strategies in aphasia therapy to improve generalization and social participation.

Purpose: Because people with aphasia (PWA) frequently interact with partners who are unresponsive to their communicative attempts, we investigated how partner responsiveness affects quantitative measures of spoken language and subjective reactions during story retell.<br><br>Method: A quantitative study and a qualitative study were conducted. In Study 1, participants with aphasia and controls retold short stories to a communication partner who indicated interest through supportive backchannel responses (responsive) and another who indicated disinterest through unsupportive backchannel responses (unresponsive). Story retell accuracy, delivery speed, and ratings of psychological stress were measured and compared. In Study 2, participants completed semistructured interviews about their story retell experience, which were recorded, transcribed, and coded using qualitative analysis software.<br><br>Results: Quantitative results revealed increased psychological stress and decreased delivery speed across all participant groups during the unresponsive partner condition. Effects on delivery speed were more consistent for controls than participants with aphasia. Qualitative results revealed that participants with aphasia were more attuned to unresponsive partner behaviors than controls and reported stronger and more frequent emotional reactions. Partner responsiveness also affected how PWA perceived and coped with the communication experience.<br><br>Conclusions: Combined quantitative and qualitative findings suggest that, while unresponsive communication partners may not have robust effects on spoken language, they elicit strong emotional reactions from PWA and affect their communication experience. These findings support the need for communication partner training and suggest that training PWA on emotion regulation or relaxation techniques may help assuage their anxiety during socially challenging everyday communication and increase social participation.

PURPOSE: Decreased social participation is one consequence<br>of aphasia that can lead to poor psychological health<br>and reduced quality of life. Involving people with aphasia in<br>advocacy efforts may be one solution for increasing their<br>social participation. The present study investigated the benefits<br>of a campus program for three people with mild aphasia<br>who were involved in educating allied health students about<br>aphasia and training them to communicate with those who<br>have aphasia. METHODS: Three participants with aphasia<br>shared their stories and interacted with interdisciplinary students<br>in two seminar sessions aimed at educating students<br>about aphasia and helping them learn strategies for supportive<br>communication with people with aphasia. A mixedmethod<br>analysis approach was used to assess the effects of<br>the program. Quantitative data were obtained via pre- and<br>post-program survey questionnaires. Qualitative data were<br>acquired through focus group interviews. RESULTS: Scores<br>on questionnaires related to communication confidence or<br>social participation were greater following program participation<br>for all three participants with aphasia and quality of<br>communication life scores were greater for one. Thematic<br>coding of focus group data confirmed that participants with<br>aphasia and their spouses perceived benefits to program<br>participation including increased social access and improved<br>self-concept. CONCLUSIONS: Findings suggest that participation<br>in community education efforts may lead to increased<br>social participation and communication confidence for<br>people with aphasia.

Purpose<br>The aims of the study were to determine dual-task effects on content accuracy, delivery speed, and perceived effort during narrative discourse in people with moderate, mild, or no aphasia and to explore subjective reactions to retelling a story with a concurrent task.<br><br>Method<br>Two studies (1 quantitative and 1 qualitative) were conducted. In Study 1, participants with mild or moderate aphasia and neurotypical controls retold short stories in isolation and while simultaneously distinguishing between high and low tones. Story retell accuracy (speech productivity and efficiency), speed (speech rate, repetitions, and pauses), and perceived effort were measured and compared. In Study 2, participants completed semistructured interviews about their story retell experience. These interviews were recorded, transcribed orthographically, and coded qualitatively using thematic analysis.<br><br>Results<br>The dual task interfered more with spoken language of people with aphasia than controls, but different speedaccuracy trade-off patterns were noted. Participants in the moderate aphasia group reduced accuracy with little alteration to speed, whereas participants in the mild aphasia group maintained accuracy and reduced their speed. Participants in both groups also reported more negative emotional and behavioral reactions to the dual-task condition than their neurotypical peers. Intentional strategies for coping with the cognitive demands of the dual-task condition were only reported by participants with mild aphasia.<br><br>Conclusion<br>The findings suggest that, although communicating with a competing task is more difficult for people with aphasia than neurotypical controls, participants with mild aphasia may be better able to cope with cognitively demanding communication situations than participants with moderate aphasia.

Purpose<br>Slowed speech and interruptions to the flow of connected speech are common in aphasia. These features are also observed during dual-task performance for neurotypical adults. The purposes of this study were to determine (a) whether indices of fluency related to cognitivelinguistic versus motor processing would differ between speakers with aphasia plus apraxia of speech (AOS) and speakers with aphasia only and (b) whether cognitive load reduces fluency in speakers with aphasia with and without AOS.<br><br>Method<br>Fourteen speakers with aphasia (7 with AOS) and 7 neurotypical controls retold short stories alone (single task) and while simultaneously distinguishing between a high and a low tone (dual task). Their narrative samples were analyzed for speech fluency according to sample duration, speech rate, pause/fill time, and repetitions per syllable.<br><br>Results<br>As expected, both speaker groups with aphasia spoke slower and with more pauses than the neurotypical controls. The speakers with AOS produced more repetitions and longer samples than controls, but they did not differ on these measures from the speakers with aphasia without AOS. Relative to the single-task condition, the dual-task condition increased the duration of pauses and fillers for all groups but reduced speaking rate only for the control group. Sample duration and frequency of repetitions did not change in response to cognitive load.<br><br>Conclusions<br>Speech output in aphasia becomes less fluent when speakers have to engage in simultaneous tasks, as is typical in everyday conversation. Although AOS may lead to more sound and syllable repetitions than normal, speaking tasks other than narrative discourse might better capture this specific type of disfluency. Future research is needed to confirm and expand these preliminary findings.

Background: Person-centered rehabilitation requires that meaningful life activities are identified on a case-by-case basis, but the discovery process can be inaccessible for clients with aphasia. Card-sorting methodology addresses core barriers and help clients communicate their preferences.<br><br>Aims: To characterize life activities that people with aphasia want to do, to estimate consistency in selections over time, and to replicate previous findings about the ability of family members and friends to identify their loved ones activity preferences.<br><br>Methods & Procedures: We administered the Life Interests and Values (LIV) Cards to 26 people with aphasia, asking them which of 95 depicted life activities they wanted to do more in their lives. Half the activity cards were presented again one to ten weeks later. Twenty family members or friends responded as proxies by selecting from a questionnaire with the same items.<br><br>Outcomes & Results: Participants with aphasia selected diverse activities, though as a group they identified significantly more activities from the social activity category than from the home and community, creative and relaxing, or physical categories. Across the repeated interviews, they selected identical activities on average 78% of the time. Item-to-item agreement between people with aphasia and their proxy responders was significantly lower at 69%.<br><br>Conclusions: People with aphasia have diverse activity interests and are reliable informants about their preferences. Because significant others have limited ability to predict these choices, their impressions are inadequate substitutes for direct interviews.

<b>Background:</b> Social validation evaluates the importance and acceptability of treatment goals, procedures, and outcomes. Previous studies for treatments that train speech production in aphasia have applied social validation during the posttreatment period or to treatment protocols that are already fully developed.<br><b>Aims:</b> The purposes of this study were to (1) examine the social validity of goals and procedures experienced in speech production treatment for people with aphasia and (2) evaluate the feasibility of procedural choice-making during such tasks.<br><b>Method:</b> Seven people with aphasia and eight speechlanguage pathologists were interviewed about previous treatment that targeted speech production. Participants were also observed and/or provided feedback following a simulated practice experience or description of practice techniques that were part of a treatment approach under development. Detailed field notes were obtained and analyzed.<br><b>Results:</b> Qualitative analysis revealed four themes: (1) experience with treatment, (2) experience with practice, (3) therapeutic engagement, and (4) procedural choice-making. The first three themes related to previous experiences with speech production treatment and the fourth pertained to comments and observations regarding the simulated practice experience.<br><b>Conclusions:</b> The variety of approaches, strategies, and cueing options that participants reported combined with comments regarding therapeutic engagement and the simulated practice indicated that people with aphasia and speechlanguage pathologists value control, choice, and flexibility when training speech production. Integrating procedural choice-making with speech production practice is feasible and has the potential to increase motivation and improve implementation.

Purpose:This study explored the acceptability and impact of relationship-centered communication partner training (RC-CPT) in couples impacted by aphasia. In particular, couples considered whether discussing their relationship roles and responsibilities was important and relevant to the changes they desire. Preliminary quasi-experimental data regarding perceived communication confidence and the marriage relationship were also obtained.Method:Three couples participated in RC-CPT across two sessions. Surveys were used to measure communication confidence and the marital relationship before and after participation in RC-CPT. The quantitative findings were analyzed using descriptive statistics. Couples also participated in a semistructured interview about the acceptability of RC-CPT during a third session. The interviews were transcribed and analyzed using reflexive codebook analysis.Results:Quantitative data indicated that participants generally maintained or improved self-rated accessibility, responsiveness, engagement, conflict resolution, and communication within their marriage after participating in RC-CPT. Additionally, individuals with aphasia demonstrated enhanced communication confidence scores. Qualitative analysis revealed three themes: (a) Impact on Communication, (b) Impact on Relationship, and (c) Impact on Psychosocial Well-Being. Feedback from participants regarding future development was also included.Conclusions:The convergence of quantitative and qualitative data supports the conclusion that couples experienced positive changes in their communication, relationship, and psychosocial well-being during the intervention, suggesting that RC-CPT has the potential to positively impact both communicative and psychosocial effects of aphasia on couples. Moreover, this study highlights the promise of RC-CPT as a relationship-centered counseling tool, warranting further exploratory and experimental research.

Purpose:The aim of this study was to explore the subjective experiences of people with aphasia when communicating in the presence of various types of background noise. We hypothesized that (a) people with aphasia would report greater perceived effort and stress than controls when talking in noise, (b) perceived effort and stress would be greater in noise than silence, and (c) people with aphasia would describe more negative reactions to communicating in noise than controls.Method:Eleven people with aphasia and 11 age- and gender-matched controls retold stories in a baseline silent condition and five background noise conditions (pink noise, cocktail party, monologue, one-sided phone call, and conversation) and rated their perceived effort and stress after each story. Participants then described their experience in a semistructured interview. Perceived effort and stress ratings were analyzed statistically using quantitative methods. Interview data were analyzed qualitatively.Results:Quantitative findings showed that people with aphasia reported significantly greater perceived effort and stress than controls. Across groups, phone call, conversation, and monologue conditions were perceived as either more effortful or stressful than the silent baseline condition. Although both participant groups discussed cognitive and emotional challenges and strategies related to talking in noise, qualitative findings showed distinct difficulties for people with aphasia. Specifically, unlike controls, participants with aphasia mentioned difficulty ignoring background noise, decreased processing speed, fatigue, negative emotional reactions, deliberately focusing, slowing down/taking breaks, and consciously regulating their emotions.Conclusions:Although aphasia therapy often occurs in quiet clinic environments, everyday communication does not. The increased perceived difficulty that people with aphasia have for coping with background noise should be acknowledged, and training should be designed to prepare people with aphasia to communicate in noisy environments.