Publications

Abstract

Background: The concept of fluency is widely used to dichotomously classify aphasia syndromes in both research and clinical practice. Despite its ubiquity, reliability of fluency measurement is reduced due to its multi-dimensional nature and the variety of methods used to measure it.
Aims: The primary aim of the study was to determine what factors contribute to judgements of fluency in aphasia, identifying methodological and linguistic sources of disagreement.
Methods & Procedures: We compared fluency classifications generated according to fluency scores on the revised Western Aphasia Battery (WAB-R) to clinical impressions of fluency for 254 English-speaking people with aphasia (PwA) from the AphasiaBank database. To determine what contributed to fluency classifications, we examined syndrome diagnoses and measured the predictive strength of 18 spontaneous speech variables extracted from retellings of the Cinderella story. The variables were selected to represent three dimensions predicted to underlie fluency: grammatical competence, lexical retrieval, and the facility of speech production.
Outcomes & Results: WAB-R fluency classifications agreed with 83% of clinician classifications, although agreement was much greater for fluent than nonfluent classifications. The majority of mismatches were diagnosed with anomic or conduction aphasia by the WAB-R but Broca's aphasia by clinicians. Modifying the WAB-R scale improved the extent to which WAB-R fluency categories matched clinical impressions. Fluency classifications were predicted by a combination of variables, including aspects of grammaticality, lexical retrieval and speech production. However, fluency classification by WAB-R was largely predicted by severity, whereas the presence or absence of apraxia of speech was the largest predictor of fluency classifications by clinicians.
Conclusions: Fluency judgements according to WAB-R scoring and those according to clinical impression showed some common influences, but also some differences that contributed to mismatches in fluency categorization. We propose that, rather than using dichotomous fluency categories, which can mask sources of disagreement, fluency should be explicitly identified relative to the underlying deficits (word-finding, grammatical formulation, speech production, or a combination) contributing to each individual PwA's fluency profile. Identifying what contributes to fluency disruptions is likely to generate more reliable diagnoses and provide more concrete guidance regarding therapy, avenues we are pursuing in ongoing research.

Abstract

When people talk, they gesture. Gesture is a fundamental component of language that contributes meaningful and unique information to a spoken message and reflects the speaker's underlying knowledge and experiences. Theoretical perspectives of speech and gesture propose that they share a common conceptual origin and have a tightly integrated relationship, overlapping in time, meaning, and function to enrich the communicative context. We review a robust literature from the field of psychology documenting the benefits of gesture for communication for both speakers and listeners, as well as its important cognitive functions for organizing spoken language, and facilitating problem-solving, learning, and memory. Despite this evidence, gesture has been relatively understudied in populations with neurogenic communication disorders. While few studies have examined the rehabilitative potential of gesture in these populations, others have ignored gesture entirely or even discouraged its use. We review the literature characterizing gesture production and its role in intervention for people with aphasia, as well as describe the much sparser literature on gesture in cognitive communication disorders including right hemisphere damage, traumatic brain injury, and Alzheimer's disease. The neuroanatomical and behavioral profiles of these patient populations provide a unique opportunity to test theories of the relationship of speech and gesture and advance our understanding of their neural correlates. This review highlights several gaps in the field of communication disorders which may serve as a bridge for applying the psychological literature of gesture to the study of language disorders. Such future work would benefit from considering theoretical perspectives of gesture and using more rigorous and quantitative empirical methods in its approaches. We discuss implications for leveraging gesture to explore its untapped potential in understanding and rehabilitating neurogenic communication disorders.

Abstract

Background: While persons with aphasia (PwA) are often dichotomised as fluent or nonfluent, agreement that fluency is not an all-or-nothing construct has led to the use of continuous variables as a way to quantify fluency, such as multi-dimensional rating scales, speech rate, and utterance length. Though these measures are often used in research, they provide little information about the underlying fluency deficit.
Aim: The aim of the study was to identify how well commonly used continuous measures of fluency capture variability in spontaneous speech variables at lexical, grammatical, and speech production levels. Methods & Procedures: Speech samples of 254 English-speaking PwA from the AphasiaBank database were analyzed to examine the distributions of four continuous measures of fluency: the WAB-R fluency scale, utterance length, retracing, and speech rate. Linear regression was used to identify spontaneous speech predictors contributing to each fluency outcome measure.
Outcomes & Results: All the outcome measures reflected the influence of multiple underlying dimensions, although the predictors varied. The WAB-R fluency scale, speech rate, and retracing were influenced by measures of grammatical competence, lexical retrieval, and speech production, whereas utterance length was influenced only by measures of grammatical competence and lexical retrieval. The strongest predictor of WAB-R fluency was aphasia severity, whereas the strongest predictor for all other fluency proxy measures was grammatical complexity.
Conclusions: Continuous measures allow a variety of ways to objectively quantify speech fluency; however, they reflect superficial manifestations of fluency that may be affected by multiple underlying deficits. Furthermore, the deficits underlying different measures vary, which may reduce the reliability of fluency diagnoses. Capturing these differences at the individual level is critical to accurate diagnosis and appropriately targeted therapy.