Faculty: Tyson Harmon

Purpose: 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.
Method: 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.
Results: 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.
Conclusions: 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.

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.

Background. 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 investigate (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.
Methods. 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.
Results. 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.
Discussion. 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: 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.
Method: 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.
Results: 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.
Conclusions: 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.

Background: 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.
Aims: 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.
Method: 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.
Results: 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.
Conclusions: 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.

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.

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.

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

Purpose
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 cognitive–linguistic 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.

Method
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.

Results
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.

Conclusions
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.

Purpose
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.

Method
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.

Results
The dual task interfered more with spoken language of people with aphasia than controls, but different speed–accuracy 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.

Conclusion
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.

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.

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.

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.

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%.

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.

Background: 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.
Aims: 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.
Method: Seven people with aphasia and eight speech–language 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.
Results: 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.
Conclusions: 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 speech–language 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.