Affiliation:
1. Northeastern University, Portland, ME
2. University of Pittsburgh, PA
3. VA Pittsburgh Healthcare System, PA
4. Carnegie Mellon University, Pittsburgh, PA
5. The University of Utah, Salt Lake City
6. Portland State University, OR
Abstract
Purpose:
Individuals with aphasia identify discourse-level communication (i.e., language in use) as a high priority for treatment. The central premise of most aphasia treatments is that restoring language at the phoneme, word, and/or sentence level will generalize to discourse. However, treatment-related changes in discourse-level communication are modest, are poorly understood, and vary greatly among individuals with aphasia. In response, this study consisted of a multilevel discourse analysis of archival, monologic discourse outcomes across two high-intensity Semantic Feature Analysis (SFA) clinical trials. Aim 1 evaluated changes in theoretically motivated discourse outcomes representing lexical–semantic processing, lexical diversity, grammatical complexity, and discourse informativeness. Aim 2 explored the potential moderating role of nonlanguage cognitive factors (semantic memory, divided attention, and executive function) on discourse outcomes.
Method:
This study was a retrospective analysis of archival monologic discourse outcomes after intensive SFA for
n
= 60 (Aim 1) and a subset
n
= 44 (Aim 2). Outcome measures included lexical–semantic processing (% semantic errors), lexical diversity (moving average type–token ratio), grammatical complexity (mean utterance length), and discourse informativeness (% correct information units). Bayesian generalized mixed-effects models were used to examine changes across four study time points: enrollment, entry, exit, and 1-month follow-up.
Results:
The present study found no evidence for meaningful or statistically reliable improvements in monologue discourse performance after SFA when measured using standard, general-topic discourse stimuli. There was weak and inconsistent evidence that nonlanguage cognitive factors may play a role in moderating treatment response.
Conclusions:
These findings indicate a clear need to pair theoretically informed treatments designed to facilitate generalization to discourse with intentional measurement paradigms designed to capture it. Furthermore, there is a clear need to examine how established treatments, restorative or compensatory, can better facilitate generalization to discourse-level communication. These priorities are critical for meaningfully improving everyday communication and reducing the profound communication and psychosocial consequences of aphasia.
Supplemental Material:
https://doi.org/10.23641/asha.26524081
Publisher
American Speech Language Hearing Association