American Journal of Speech-Language Pathology最新文献

Purpose: Most individuals with aphasia want to improve their reading and writing, yet these language skills are not typically prioritized in aphasia therapy. This study aimed to better understand speech-language pathologists' clinical practice regarding rehabilitation of reading and writing with clients with aphasia.

Method: Twenty-one speech-language pathologists completed an online survey with questions addressing clinical experience, feelings, and therapy approaches surrounding literacy and aphasia. Descriptive statistics were used to analyze closed-ended responses, and content analysis was performed on open-ended responses. Associations between participant demographics and survey self-ratings were explored.

Results: Speech-language pathologists indicated that reading and writing are important to address in aphasia therapy, yet many indicated low satisfaction with available assessments and treatments and low confidence in their abilities to address literacy challenges. Most reported observing reading and writing to be problematic for clients with aphasia; however, there was variability in frequency and type of assessments and treatments used to address these concerns. The number of reported clients with aphasia on caseload was significantly correlated with higher confidence and more frequent treatment for reading and writing.

Conclusions: Participants agreed it is important to address literacy skills with clients with aphasia; however, many reported low confidence, time constraints, and other barriers interfering with their ability to do so. Research focused on improving educational training opportunities and access to literacy resources for speech-language pathologists is needed to support their clinical care and meet the literacy needs of individuals with aphasia.

Supplemental material: https://doi.org/10.23641/asha.30080956.

Purpose: Multimodal Communication Treatment with discourse via telepractice (teleMCT+D) is a modified version of Multimodal Communication Treatment for people with aphasia to expand instruction in resolving communication breakdowns to the discourse level. Due to potential barriers to telepractice with nonspoken communication modalities, we aimed to evaluate its feasibility in a single-subject design study.

Method: Two people with aphasia completed teleMCT+D across 10 weeks (two 1-hr sessions per week) and posttreatment interviews. The feasibility was evaluated for the five categories (recruitment, data collection, acceptability, resources, and responses) from Orsmond and Cohn (2015). Each category of feasibility was evaluated by several outcome measures.

Results: Findings demonstrated high feasibility for recruitment and data collection, although one participant's assessment fidelity was moderate. Participants found teleMCT+D to be acceptable. They viewed the telepractice format positively; however, minimal negative reactions and events were also reported. Regarding resources, all participants and care partners had the technology skills and materials needed to participate. Additional resources, including clinician training, supervision, and regular team meetings, assured ethical conduct. Finally, the treatment response results showed mixed effects on accuracy and nonspoken modality use but no improvement in spoken modality productions. Participants also reported that they used nonspoken modalities (e.g., gesturing) frequently for daily conversations.

Conclusions: We discussed the advantages and challenges of teleMCT+D based on the feasibility results such as limited view and control of the environment, which limited nonspoken modality training at times. Future directions include following the suggested modifications in a large sample with various types and severities of aphasia. Preliminary evidence supporting that a telepractice format for communication breakdown resolution treatment for people with aphasia is feasible and acceptable can provide better access to underserved populations.

Purpose: Although Black Americans are more likely to have strokes and more severe poststroke disability than White Americans, Black stroke survivors with aphasia are substantially underrepresented in aphasia clinical trials, which means that research findings may not generalize to the entire U.S. population. To help address this issue, we completed a 12-month community outreach pilot seeking to increase representation and engagement of Black stroke survivors with aphasia in research and to identify barriers to aphasia research participation and the unmet community needs of this population.

Method: Targeted community outreach in predominantly Black neighborhoods was led by a Community Outreach Ambassador and consisted of site visits, tabling at community events, and providing a free monthly aphasia support group. Understanding barriers and unmet needs relied on qualitative analysis of semistructured interviews completed with Black stroke survivors with aphasia.

Results: We completed over 20 unique points of contact with organizations in the Pittsburgh community and had conversations with over 100 Black stroke survivors or their family members, but these efforts resulted in limited new referrals. Semistructured interviews of four Black stroke survivors with aphasia identified participation barriers in the areas of knowledge and transportation, and unmet community needs related to communication deficits, social isolation, and poor mental health.

Conclusions: While our pilot did not substantially increase referrals for Black stroke survivors with aphasia during the study period, it helped identify key barriers to research participation. We have also experienced positive signs of continued community growth and relationship building since completing the study. Overall, this community outreach pilot provides preliminary guidance and "lessons learned" for those seeking to increase participation and community collaboration with Black stroke survivors with aphasia.

Supplemental material: https://doi.org/10.23641/asha.29904884.

Purpose: Motivation influences clinical decisions and neurocognitive processes central to aphasia rehabilitation, yet clinicians lack evidence-based frameworks to guide the assessment and management of motivation. Self-determination theory is a well-validated psychological framework that proposes that motivation is supported by the satisfaction of three basic psychological needs (BPNs), autonomy, competence, and relatedness. The measurement of these BPNs could improve aphasia treatment outcomes by identifying causes of poor motivation and strategies to enhance motivation. To support the assessment and management of motivation in aphasia rehabilitation, we evaluated the validity of the Basic Psychological Needs Satisfaction and Frustration Scale (BPNS/F) in people with aphasia.

Method: Seventy-seven people with aphasia completed the BPNS/F comprising six 4-item subscales for satisfaction and frustration of autonomy, competence, and relatedness. Responses were collected via a 5-point Likert scale. We evaluated validity with respect to the (a) internal structure via confirmatory factor analysis, (b) internal consistency reliability, and (c) relationship to theoretically related constructs.

Results: The BPNS/F's internal structure was consistent with previous findings in nonaphasic adults. Internal consistency reliability was near or above the acceptable range for group but not individual-level analyses. We found that autonomy and competence were both strongly related to depression. Communication was the only health-related quality of life variable related to BPNS/F factors.

Conclusion: Future research aimed at modifying the BPNS/F to align with the linguistic abilities and experiences of people with aphasia in rehabilitation may offer a means to measure BPNs in people with aphasia and support the integration of motivational theory into aphasia clinical practice and research.

Supplemental material: https://doi.org/10.23641/asha.29319224.

Purpose: Digital domains are becoming increasingly important in creating and sustaining relationships. The purpose of this study was to understand the role of information and communication technology (ICT) in maintaining friendships for people with aphasia. Understanding how people with aphasia use ICT (e.g., smartphones, social media platforms) to stay connected is critical to developing components of clinical interventions focused on social relationships.

Method: Data were collected from a larger qualitative research project and included semistructured interviews about friendship maintenance and aphasia. Participants included 27 people with aphasia, eight significant others, and nine friends of people with aphasia. Data were analyzed according to inductive thematic analysis.

Results: The majority (> 90%) of participants emphasized the importance of ICT in maintaining friendships. Three themes were generated from the analysis: (a) flexibility is a core component of technology use, (b) the role of technology in identity negotiation, and (c) technology as a lifeline.

Conclusions: Findings indicate that ICT has a vital role in helping people with aphasia maintain friendships. Themes generated highlight important aspects that may be ignored in the rehabilitation process, such as the need for flexibility, the importance of identity negotiation in online spaces, and the need for training and support in digital technology use. These findings have clinical and research implications that can be further developed to help people with aphasia maintain friendships.

Purpose: Despite an abundance of manual, labor-intensive discourse analysis methods, there remains a dearth of clinically convenient, psychometrically robust instruments to measure change in real-world communication in aphasia. The Brief Assessment of Transactional Success (BATS) addresses this gap while developing automated methods for analyzing story retelling discourse. This study investigated automation of main concept (MC) analysis of stories by comparing scores from three large language models (LLMs) to those of human raters.

Method: After watching/listening to each of the eight short video/audio BATS stimuli and retelling each story, 96 persons with aphasia (PWA; n = 48 female) engaged in topic-constrained conversations over Zoom with 94 familiar and 107 unfamiliar conversation partners (CPs). CPs then retold each story as co-constructed during their conversations with PWA. Audio files from the resulting 1,760 story retells were transcribed using Python and AssemblyAI's speech-to-text application programming interface. Each MC was first scored by human raters for presence, accuracy, and completeness. Raters used a semiautomated application, MainConcept. For each transcript, an MC composite ratio score was obtained. We evaluated three state-of-the-art LLMs: two proprietary models, GPT-4 and GPT-4o, and one open-source model, Llama-3-70B. The interrater reliability between each LLM versus human MC scoring was assessed via the Pearson correlation coefficient and reliability coefficients based on the generalizability theory (G-theory).

Results: The Pearson correlation coefficients indicate strong positive linear relationships between LLM and human MC scores. G-theory reliability coefficients also indicate reliable scoring between LLM and human scoring across the spectrum of participants and conditions.

Conclusions: This promising proof-of-concept study affirms the reliability of three LLMs in evaluating BATS story retell MCs and justifies ongoing investigation into their use. Providing clinicians and clinical researchers with automated tools for analyzing discourse without the need for prohibitively labor-intensive manual scoring could be a paradigm shift, potentially revolutionizing the aphasia intervention landscape.

Purpose: Approximately 44% of individuals with chronic aphasia also present with apraxia of speech, necessitating integrated treatment approaches to optimize recovery. This study examined the effects of a combined treatment protocol, leveraging Treatment of Underlying Forms (TUF) and a modified version of Sound Production Treatment (SPT), on language and speech outcomes in individuals with mild aphasia and apraxia.

Method: Three participants underwent treatment involving alternating and combined TUF and modified SPT. The pre- and posttreatment assessments included standardized and treatment-specific speech and language measures.

Results: The results indicated significant improvements in the production of both trained and untrained items with similar syntactic and articulatory complexities, whereas generalization to simpler targets varied among participants.

Conclusion: Our findings suggest that combined TUF/modified SPT may enhance speech and language outcomes, warranting further investigation of individual variability in treatment responses and generalization patterns.

Purpose: A stakeholder-engaged, collaboratively developed video biopic about the lived experience of primary progressive aphasia (PPA) was examined to assess its impact on graduate students' understanding of the lived experience of PPA and best practice principles in PPA.

Method: Using a post-then-pre-design, 22 graduate students were surveyed after watching the biopic regarding their understanding of the neurological aspects of PPA and the lived experience of PPA. Additionally, they mapped the presence of Volkmer et al.'s (2023) PPA best practice principles within the biopic. Quantitative measures of central tendency, as well as qualitative measures, were used to analyze the data. Reflexive thematic analysis was used to identify themes related to understanding of the neurological and lived experience components of PPA prior to and after watching the biopic.

Results: After viewing the biopic, participants identified significant changes in understanding both the neurological aspects of PPA and the lived experience of PPA. However, their reported understanding of the lived experience of PPA was more influenced, impactful, and relevant than the changes in their understanding of the neurological aspects. Students identified occurrence of all seven PPA best practice principles within the biopic.

Conclusions: Students reported significant changes in understanding prior to and following viewing the biopic. Video biopics may be an effective tool to support increased understanding of the lived experience of conditions, including PPA, and support increased awareness and application of evidence-based practices.

Purpose: This study investigated the experiential perceptions of speech-language pathology graduate clinicians involved in a caregiver coaching clinical practicum.

Method: Employing a mixed-method approach combining reflexive thematic analysis and a paired-samples t test, this study examined speech-language pathology graduate clinicians' perceived development of self-efficacy and indirect acquisition of foundational counseling skills with a focus on how these skills informed the formation of therapeutic alliances with infant caregivers. Data were gathered through focus group interviews and the completion of a counseling self-efficacy (CSE) rating scale. Pre- and post-self-ratings of CSE were collected for comparison.

Results: Thematic analysis revealed one major theme, building connections, and three subthemes, highlighting challenges in communication, power dynamics, and role establishment with infant caregivers. While overall CSE ratings improved post program, specific subscale ratings remained low, indicating the need to enhance preprofessional preparation in complex counseling skills and emotional support provision.

Conclusions: The findings underscore the importance of preprofessional preparation for building therapeutic alliances and facilitating collaborative communication with caregivers. They also emphasize areas for strengthening the preprofessional training of speech-language pathology graduate clinicians in early intervention services.

Purpose: The current study investigated the impact of a short mobile training implemented in peer pairs to teach the Communicating Choices-CVI (Peers) strategy to support interactions with students with multiple disabilities.

Method: A pretest-posttest control group design was used to evaluate the effects of the training created on the INSTRUCT app, which used a checklist of steps with video models to teach elementary-age peers a strategy to structure opportunities for students with multiple disabilities to communicate choices. Peers were randomly assigned to the experimental group (n = 10) or control group (n = 10) and then video-recorded while interacting with students with multiple disabilities during one pretest and one posttest interaction in their typical educational settings. Peers in the experimental group completed the training between the pretest and posttest; peers in the control group did not.

Results: The training was found to be both efficient and effective with limited adult involvement required. Following the training, which took approximately 23 min, peers in the experimental group demonstrated statistically significant gains in accuracy of strategy substep implementation, which led to increased successful communication by the students with multiple disabilities.

Conclusions: This is the first communication partner training study to investigate the impact of the INSTRUCT app and peer pairs to teach a strategy for structuring opportunities to communicate choices to students with multiple disabilities including cortical visual impairment (CVI). By investigating the outcomes of the training in a real-world context (i.e., school environment), the results offer information that is directly transferrable and applicable to clinicians who may be interested in implementation of similar procedures.

Supplemental material: https://doi.org/10.23641/asha.29996182.