An international core outcome set for primary progressive aphasia (COS-PPA): Consensus-based recommendations for communication interventions across research and clinical settings.

Introduction: Interventions to treat speech-language difficulties in primary progressive aphasia (PPA) often use word accuracy as a highly comparable outcome. However, there are more constructs of importance to people with PPA that have received less attention.

Methods: Following Core Outcome Set Standards for Development Recommendations (COSSTAD), this study comprised: Stage 1 - systematic review to identify measures; Stage 2 - consensus groups to identify important outcome constructs for people with PPA (n = 82) and care partners (n = 91); Stage 3 - e-Delphi consensus with 57 researchers.

A Wearable System for Continuous Monitoring and Assessment of Speech, Gait, and Cognitive Decline for Early Diagnosis of ADRD.

Early detection of cognitive decline is essential to study mild cognitive impairment and Alzheimer's Disease in order to develop targeted interventions and prevent or stop the progression of dementia. This requires continuous and longitudinal assessment and tracking of the related physiological and behavioral changes during daily life. In this paper, we present a low cost and low power wearable system custom designed to track the trends in speech, gait, and cognitive stress while also considering the important human factor needs such as privacy and compliance.

Normative Values for Word Syllable Duration With Interpretation in a Large Sample of Stroke Survivors With Aphasia.

Purpose: Slow speech rate and abnormal temporal prosody are primary diagnostic criteria for differentiating between people with aphasia who do and do not have apraxia of speech. We sought to identify appropriate cutoff values for abnormal word syllable duration (WSD) in a word repetition task, interpret them relative to a data set of people with chronic aphasia, and evaluate the extent to which manually derived measures could be approximated through an automated process that relied on commercial speech recognition technology.

Method: Fifty neurotypical participants produced 49 multisyllabic words during a repetition task.

Barriers to Informational Support for Care Partners of People With Aphasia After Stroke.

Background: Care partners of people with aphasia after stroke need various informational supports, such as aphasia education and resources for psychosocial support. However, informational support may vary across clinicians, and access to these supports remains a persistent unmet need. Using implementation science frameworks can help to assess the gap between what is known about an issue and what is occurring in practice.

Do People With Apraxia of Speech and Aphasia Improve or Worsen Across Repeated Sequential Word Trials?

Purpose: During motor speech examinations for suspected apraxia of speech (AOS), clients are routinely asked to repeat words several times sequentially. The purpose of this study was to understand the task in terms of the relationship among consecutive attempts. We asked to what extent phonemic accuracy changes across trials and whether the change is predicted by AOS diagnosis and sound production severity.

Motivation in Aphasia Treatment: Self-Determination Theory Applied to the FOURC Model.

Purpose: Although the importance of motivation to successful rehabilitation is frequently acknowledged in the aphasia literature, little evidence-based guidance has been provided on how to support it. The purpose of this tutorial is to introduce a well-validated theory of motivation, self-determination theory (SDT); explain its role as the foundation for the FOURC model of collaborative goal setting and treatment planning; and explain how it may be applied during rehabilitation to support the motivation of people with aphasia.

Method: We provide an overview of SDT, explore the link between motivation and psychological wellness, and discuss how psychological needs are addressed in SDT and the FOURC model.

Three-Dimensional Speech Profiles in Stroke Aphasia and Apraxia of Speech.

Purpose: Behaviorally, acquired apraxia of speech (AOS) is a multidimensional syndrome that the experienced clinician recognizes based on impaired articulation and abnormal temporal prosody. We conducted this study to determine the extent to which three core features of AOS-when defined quantitatively-distinguish categorically among aphasia with no or minimal speech sound involvement, aphasia with AOS, and aphasia with phonemic paraphasia (APP).

Method: The study involved retrospective analysis of 195 participants with stroke-induced aphasia.

Speech patterns and enunciation for encephalopathy determination-A prospective study of hepatic encephalopathy.

Hepatic encephalopathy (HE) is a complication of cirrhosis that benefits from early diagnosis and treatment. We aimed to characterize speech patterns of individuals with HE to investigate its potential to diagnose and monitor HE. This was a single-center prospective cohort study that included participants with cirrhosis with HE (minimal HE [MHE] and overt HE [OHE]), cirrhosis without HE, and participants without liver disease.

Repeated word production is inconsistent in both aphasia and apraxia of speech.

Purpose: There is persistent uncertainty about whether sound error consistency is a valid criterion for differentiating between apraxia of speech (AOS) and aphasia with phonemic paraphasia. The purpose of this study was to determine whether speakers with a profile of aphasia and AOS differ in error consistency from speakers with aphasia who do not have AOS. By accounting for differences in overall severity and using a sample size well over three times that of the largest study on the topic to date, our ambition was to resolve the existing controversy.

Speech Metrics and Samples That Differentiate Between Nonfluent/Agrammatic and Logopenic Variants of Primary Progressive Aphasia.

Purpose Of the three currently recognized variants of primary progressive aphasia, behavioral differentiation between the nonfluent/agrammatic (nfvPPA) and logopenic (lvPPA) variants is particularly difficult. The challenge includes uncertainty regarding diagnosis of apraxia of speech, which is subsumed within criteria for variant classification. The purpose of this study was to determine the extent to which a variety of speech articulation and prosody metrics for apraxia of speech differentiate between nfvPPA and lvPPA across diverse speech samples.

Main Concept, Sequencing, and Story Grammar Analyses of Cinderella Narratives in a Large Sample of Persons with Aphasia.

Recently, a multilevel analytic approach called Main Concept, Sequencing, and Story Grammar (MSSG) was presented along with preliminary normative information. MSSG analyses leverage the strong psychometrics and rich procedural knowledge of both main concept analysis and story grammar component coding, complementing it with easy-to-obtain sequencing information for a rich understanding of discourse informativeness and macrostructure. This study is the next critical step for demonstrating the clinical usefulness of MSSG's six variables (main concept composite, sequencing, main concept+sequencing, essential story grammar components, total episodic components, and episodic complexity) for persons with aphasia (PWAs).

Measuring Lexical Diversity for Discourse Analysis in Aphasia: Moving-Average Type-Token Ratio and Word Information Measure.

Purpose The purpose of this study was to compare the utility of two automated indices of lexical diversity, the Moving-Average Type-Token Ratio (MATTR) and the Word Information Measure (WIM), in predicting aphasia diagnosis and responding to differences in severity and aphasia subtype. Method Transcripts of a single discourse task were analyzed for 478 speakers, 225 of whom had aphasia per an aphasia battery. We calculated the MATTR and the WIM for each participant.

How Responsiveness From a Communication Partner Affects Story Retell in Aphasia: Quantitative and Qualitative Findings.

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).

Subjective Communication Difficulties in Very Mild Aphasia.

Purpose In comparison to the large literature on moderate to severe aphasia, very little is known about aphasia of the mildest severity and whether intervention may be warranted. The purpose of this pilot study was to characterize challenges experienced by people who have recovered to the point that they score normally on aphasia batteries yet report they continue to have aphasia. Method Five people with aphasia who scored above the Western Aphasia Battery-Aphasia Quotient (Kertesz, 2007) cutoff for aphasia participated in a semistructured interview.

Speech Fluency in Acquired Apraxia of Speech During Narrative Discourse: Group Comparisons and Dual-Task Effects.

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.

Dual-Task Effects on Story Retell for Participants With Moderate, Mild, or No Aphasia: Quantitative and Qualitative 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.

Automating Error Frequency Analysis via the Phonemic Edit Distance Ratio.

Purpose Many communication disorders result in speech sound errors that listeners perceive as phonemic errors. Unfortunately, manual methods for calculating phonemic error frequency are prohibitively time consuming to use in large-scale research and busy clinical settings. The purpose of this study was to validate an automated analysis based on a string metric-the unweighted Levenshtein edit distance-to express phonemic error frequency after left hemisphere stroke.

Automated Speech Recognition in Adult Stroke Survivors: Comparing Human and Computer Transcriptions.

Objective: Speech sound errors are common in people with a variety of communication disorders and can result in impaired message transmission to listeners. Valid and reliable metrics exist to quantify this problem, but they are rarely used in clinical settings due to the time-intensive nature of speech transcription by humans. Automated speech recognition (ASR) technologies have advanced substantially in recent years, enabling them to serve as realistic proxies for human listeners.

Collaborative Goals for Communicative Life Participation in Aphasia: The FOURC Model.

Purpose Collaborative goal setting is at the heart of person-centered rehabilitation but can be challenging, particularly in the area of aphasia. The purpose of this clinical focus article is to present a step-by-step model for forming a collaborative partnership with clients to develop an intervention plan that follows the client's lead, addresses communicative participation, and integrates multiple treatment strategies. Method We introduce the rationale and core features of a 4-step and 4-pronged process (the FOURC model) and illustrate its application through 3 cases of people with aphasia who were treated in outpatient rehabilitation.

Sound Distortion Errors in Aphasia With Apraxia of Speech.

Purpose Loosely defined diagnostic criteria for acquired apraxia of speech (AOS) limit clinicians' ability to diagnose the disorder validly and reliably. The purpose of this study was to contribute to the development of more precise diagnostic guidelines by characterizing the frequency and quality of sound distortion errors in speakers with clinically diagnosed AOS. Method Audio-recorded motor speech evaluations from 24 speakers with AOS and aphasia were analyzed by trained listeners using a narrow phonetic transcription protocol that included 12 distortion categories.

Caregivers navigating rehabilitative care for people with aphasia after stroke: a multi-lens perspective.

Background: Up to 40% of stroke survivors acquire aphasia and require long-term caregiver assistance after discharge from the hospital. Caregivers assume multiple roles as they help people with aphasia to access outpatient rehabilitative care in an increasingly person-centred model of care. Examining caregiver roles and how different stakeholders in the rehabilitative journey perceive these roles may be the first step in providing more tailored support to caregivers and improving outcomes for both caregivers and people with aphasia.

Word-level prosodic measures and the differential diagnosis of apraxia of speech.

Impaired production of prosody is considered a primary diagnostic criterion for apraxia of speech. In this study, we examined diagnostic relevance for five word-level prosody measures. Seven speakers with AOS, nine with aphasia and no AOS, and 19 age-matched neurotypical controls produced nine words consisting of three or four syllables.

Error Consistency in Acquired Apraxia of Speech With Aphasia: Effects of the Analysis Unit.

Purpose: Diagnostic recommendations for acquired apraxia of speech (AOS) have been contradictory concerning whether speech sound errors are consistent or variable. Studies have reported divergent findings that, on face value, could argue either for or against error consistency as a diagnostic criterion. The purpose of this study was to explain discrepancies in error consistency results based on the unit of analysis (segment, syllable, or word) to help determine which diagnostic recommendation is most appropriate.

Perceptually Salient Sound Distortions and Apraxia of Speech: A Performance Continuum.

Purpose: We sought to characterize articulatory distortions in apraxia of speech and aphasia with phonemic paraphasia and to evaluate the diagnostic validity of error frequency of distortion and distorted substitution in differentiating between these disorders.

Method: Study participants were 66 people with speech sound production difficulties after left-hemisphere stroke or trauma. They were divided into 2 groups on the basis of word syllable duration, which served as an external criterion for speaking rate in multisyllabic words and an index of likely speech diagnosis.

Recovering With Acquired Apraxia of Speech: The First 2 Years.

Purpose: This study was intended to document speech recovery for 1 person with acquired apraxia of speech quantitatively and on the basis of her lived experience.

Method: The second author sustained a traumatic brain injury that resulted in acquired apraxia of speech. Over a 2-year period, she documented her recovery through 22 video-recorded monologues.