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Research into language disorders such as aphasia and what they can reveal about the cognitive and neural underpinnings of language should be informed by crosslinguistic descriptions. It is particularly important to include languages that are highly dissimilar to widely studied languages like English. Kalaallisut (West Greenlandic) is one such language - a polysynthetic language of the Inuit-Yupik-Unangan language family spoken by approximately 60,000 people in Greenland and Denmark. Previous research has indicated that non-fluent aphasia in Kalaallisut exhibits different features from those found in English and similar Indo-European languages. However, previous research in this area has been limited by a low number of participants, a focus only on semispontaneous speech narratives, and the fact that a more complete description of aphasia in Kalaallisut has not been available. An essential prerequisite for incorporating data from an underresearched language in aphasiology is having sufficient information to reliably identify speakers with aphasia in that language. Gaining such information was the main aim of the present study where we tested a total of 42 speakers of Kalaallisut on repetition tests, language production tests, language comprehension tests, and working memory tests. We used a combination of qualitative judgements by a speech and language pathologist and hierarchical cluster analysis to analyse the results and were able to distinguish between presence or absence of aphasia, between levels of severity of aphasia, between apraxia of speech/dysarthria and aphasia, and to some extent between different aphasia subtypes.

Assessment tools for diagnosing aphasia in languages other than English are scarce, particularly for minority languages such as Catalan. The present study introduces the Catalan adaptation of the Comprehensive Aphasia Test (CAT-CAT), the first assessment tool of its kind in Catalan, which was developed with careful consideration of cultural and psycholinguistic factors. Additionally, the study provides normative data based on a sample of 110 Catalan-dominant speakers without language or speech disorders in order to establish the range of non-pathological performance and cut-off scores. We also examined the role of sociodemographic factors on language skills in multilingual speakers of a minority language, a topic often overlooked in the literature. Our findings show that subtests evaluating writing skills in Catalan-speaking individuals are less reliable than those assessing oral abilities, as many Catalan speakers have not received formal instruction in their mother tongue. This factor influences performance more than other variables, such as education level. Notably, language-mixing effects from Spanish were observed mainly in specific production subtests. These findings emphasize the need for language-specific adaptations and, therefore, the value of the CAT-CAT as a tool for both clinical and research purposes in aphasiology.

Prior studies report mixed associations between attention and language in people with aphasia (PWA), raising the possibility that their relationship may be influenced by another factor, such as aphasia severity. We examined this possibility by testing whether alerting, orienting, and executive control attention vary as a function of aphasia severity and whether severity statistically mediates their association with sentence comprehension. In a retrospective analysis combining data from two prior studies, 58 individuals with aphasia, ranging from latent to severe, and 21 neurotypical controls completed the Attention Network Test and a sentence-picture matching task. Group differences in attention were assessed using ANOVAs, and linear mixed-effects models evaluated the presence of each attentional effect within groups. Correlations and structural equation modeling examined associations among attention, aphasia severity, and sentence comprehension. All three attention types were present in the control and mild aphasia groups; only orienting and executive control were observed in the latent group, and only executive control in the moderate and severe groups. Orienting and executive control performance declined with increasing aphasia severity, whereas alerting did not differ by severity. Stronger orienting and executive control were associated with more efficient sentence comprehension, but this relationship was statistically mediated by aphasia severity. These findings suggest that associations between domain-general attention and sentence comprehension are best understood within the broader context of aphasia severity and highlight the need for future research clarifying the directionality of this relationship.

Research in aphasiology is largely not accessible. Almost none of the articles published in the field's rich, over 150-year history are communicated in a way that is understandable to those who could benefit from them the most-individuals with aphasia and their loved ones. In this tutorial, we detail how researchers in any field of aphasiology can create aphasia-friendly research summaries of their scientific publications. This step-by-step guide in eight simple parts covers principles of aphasia-friendly written communication (e.g., use of plain language and supportive icons and images) and makes use of freely available resources. We also introduce a prototype tool-Article Friend-that automatically generates aphasia-friendly abstracts to jump-start this process for researchers; this preliminary tool serves as a proof of concept that creating accessible research can be an efficient, sustainable practice in the scientific publishing landscape. The tutorial provides researchers with specific tools and examples to effectively and easily create aphasia-friendly summaries of their publications. Principles from our tutorial extend beyond aphasia and can apply to consumers affected by other communication and cognitive disorders, such as developmental language disorder, dementia, and traumatic brain injury. Making research available to patient stakeholders and their loved ones can empower them to access and understand the research they have contributed to, ultimately furthering increased community engagement and interchange between researchers, clinicians, consumers with aphasia, and policymakers. https://doi.org/10.23641/asha.28590227.

People with post-stroke aphasia present with disproportionate rates of chronic stress, which can lead to devastating physical and mental health consequences. This research aims to explore the sources of day-to-day, perceived stress experienced by people with aphasia to inform future longitudinal studies. Methods informed by grounded theory were used. Fifteen people with chronic post-stroke aphasia completed a one-hour semi-structured interview with a certified speech-language pathologist. Participants responded to questions about sources of stress while living with aphasia. Data were coded to identify overarching themes and sub-themes. Interview data showed complex, multifaceted relationships between stress, personal experiences, and cognitive-emotional reactions reported by people with aphasia. Axial themes included communication deficits, state of functional abilities and independence, social isolation, loss of roles and identity, public misunderstanding, fatigue and frustration, and factors unrelated to living with aphasia. Study findings underscore that the perception of stress is complex, multifactorial, and varies across individuals with aphasia. Furthermore, sources of perceived, day-to-day stress were described as interconnected and dynamic, such that stress commonly co-occurs with lived experiences. Findings from the present study provide a basis for future research to examine how acute stress may transition into chronic stress over time.

Aphasiology has a long and rich tradition of contributing to understanding how culture, language, and social environment contribute to brain development and function. Recent breakthroughs in AI can transform the role of aphasiology in the digital age by leveraging speech data in all languages to model how damage to specific brain regions impacts linguistic universals such as grammar. These tools, including generative AI (ChatGPT) and natural language processing (NLP) models, could also inform practitioners working with clinical populations in the assessment and treatment of aphasia using AI-based interventions such as personalized therapy and adaptive platforms. Although these possibilities have generated enthusiasm in aphasiology, a rigorous interrogation of their limitations is necessary before AI is integrated into practice. We explain the history and first principles of reciprocity between AI and aphasiology, highlighting how lesioning neural networks opened the black box of cognitive neurolinguistic processing. We then argue that when more data from aphasia across languages become digitized and available online, deep learning will reveal hitherto unreported patterns of language processing of theoretical interest for aphasiologists. We also anticipate some problems using AI, including language biases, cultural, ethical, and scientific limitations, a misrepresentation of marginalized languages, and a lack of rigorous validation of tools. However, as these challenges are met with better governance, AI could have an equitable impact.

Rehabilitation and the speech-language therapy profession are advancing in Malaysia, yet access to community-based rehabilitation services and self-management support for aphasia and cognitive communication disability remains unclear. This review aimed to explore the availability and accessibility of community-based rehabilitation services and self-management support for people with aphasia and cognitive communication disability in Malaysia, while also investigating the sociocultural factors influencing access. A scoping review was conducted following Arksey and O'Malley and the Joanna Briggs Institute frameworks. Structured Google searches and targeted website searches followed Godin et al. Eleven scholarly texts were included. No scholarly texts addressed cognitive communication disability or included perspectives from people with lived experience. Google searches identified 19 organisations offering aphasia or cognitive communication rehabilitation services, and one aphasia support group in Malaysia. Factors influencing access include Malaysia's multilingualism, limited speech-language therapists, lack of specialisation in aphasiology, financial constraints, and positive attitudes towards technology-based interventions. Rehabilitation services and self-management support for people with aphasia and cognitive communication disability in Malaysia are geographically inequitable. There is an urgent need for further research to support the development of community-based rehabilitation and self-management support for aphasia and cognitive communication disability in Malaysia. Speech-language therapy practices for stroke and traumatic brain injury in Malaysia should consider placing greater emphasis on communication disabilities such as aphasia and cognitive communication disability, while also promoting awareness of available rehabilitation and self-management support to improve access to care.Research on cognitive communication disability is critically needed in Malaysia to inform appropriate, evidence-based rehabilitation and support.Technology-based interventions show potential in enhancing aphasia rehabilitation and self-management support in Malaysia, particularly in underserved areas.The development of rehabilitation services and self-management support for people with aphasia and cognitive communication disability in Malaysia could benefit from adopting user-centred approaches that actively engage individuals with lived experience and are responsive to their needs.

There is a crucial need to improve cultural and linguistic representation in the field of aphasia research and in clinical practice. One way to increase representation in the field of aphasiology is by adapting treatments to the diverse cultures and languages of the world. Adapting existing evidence-based interventions for diverse cultural contexts increases fit, acceptability, engagement, and access to aphasia interventions. However, such adaptations must be approached systematically and with careful documentation of the process. This paper aims to 1) present frameworks that can guide cultural and linguistic adaptations of aphasia treatments (i.e. bottom-up and top-down approaches), and 2) present a framework that can guide the documentation of critical elements that must be considered and reported when adapting aphasia treatments. This discussion paper examines bottom-up and top-down approaches for adapting aphasia treatments to diverse linguistic and cultural contexts. It also introduces a practical framework to support researchers and clinicians in systematically documenting these adaptations. The arguments presented here are based on a critical review of the relevant literature. Illustrative examples are provided to demonstrate how these approaches and the framework can be applied. The approaches and the framework discussed in this paper can help clinicians and researchers adapt evidence-based treatments for aphasia, document their adaptation process, and trace a path for future treatment modifications. This paper could provide much-needed support for increasing aphasia intervention development and research for diverse cultures and languages, thereby increasing access to appropriate interventions for all persons with aphasia and their care partners.

The extent to which bilingual individuals represent and process their two languages within a shared or partially distinct neural architecture remains a topic of ongoing debate. While both parallel and divergent patterns of impairment have been reported in bilingual aphasia, such findings likely reflect a spectrum of representational overlap influenced by dominance, proficiency, and task demands. Critically, few studies have examined how breakdown manifests across multiple levels of linguistic structure using ecologically valid, discourse-based tasks. This study investigates whether Spanish-English bilinguals with aphasia exhibit parallel or dissociable patterns of impairment across their two languages, focusing on naturalistic narrative production and fine-grained analysis of speech error types and code-switching. Thirteen bilingual individuals with aphasia following acquired brain injury produced story retellings in both languages. Speech samples were transcribed and coded for phonological, morphological, syntactic, and semantic errors, and for the word type at which they occurred. Code-switches were also identified and categorized along the same dimensions. Analyses included generalized linear modeling, unsupervised clustering, and supervised machine learning methods. While participants made more errors in their non-dominant than in their dominant language, the structure and distribution of errors were highly similar across languages. Clustering algorithms and supervised classification analyses revealed that impairments were parallel across dominant and non-dominant languages. Code-switching occurred more frequently from the non-dominant to the dominant language, consistent with activation-based lexical selection. Findings support an integrated bilingual language system that spans multiple levels of linguistic representation, modulated by language dominance. Naturalistic discourse tasks allow for richer characterization of bilingual language breakdown and may better inform both theoretical models and clinical management of bilingual aphasia.

With the global population aging, the incidence of stroke is rising, often resulting in motor dysfunction, speech disorders, and swallowing difficulties, significantly affecting daily life and social participation. Speech and language disorders notably impair communication and restrict social engagement, making speech rehabilitation a critical intervention. However, comprehensive bibliometric analyses on post-stroke language rehabilitation are limited, restricting understanding of progress in this field. This study aimed to identify hotspots and trends in post-stroke speech rehabilitation research from 2003 to 2023 to guide future studies. Articles on post-stroke speech rehabilitation from 2003 to 2023 were retrieved from the Web of Science Core Collection. Analyses included annual publications, key authors, countries, institutions, journals, co-citations, and keywords. Among 1077 articles, publication volume showed an upward trend, with the United States leading in contributions. The Aphasiology journal published the most articles, and prominent institutions like the University of Queensland demonstrated significant publication and citation impact. Key trends included "communication disorders," "functional connectivity," and "melodic intonation therapy," with "stroke" and "aphasia" emerging as central keywords. Research in post-stroke speech rehabilitation is increasing, with significant contributions from the United States and key institutions. Trends highlight the importance of communication-focused therapies and innovative techniques like melodic intonation therapy. This study provides insights into research directions.

Current clinical approaches to the treatment of spoken word-finding difficulties in acquired aphasia encourage multimodal cueing, especially the joint application of written and spoken forms. Research that exclusively examines the effects and mechanisms of written cues is limited, with most studies engaging written forms only as part of a multimodal therapy. Parameters for ideal orthographic cue size and mode of delivery have yet to be determined, and the duration of orthographic facilitation effects needs to be clarified. (1) What is the optimal unit of orthographic cueing (single letter or the entire word) and how durable are the effects (length of time that naming remains successful post-cueing)? (2) Are orthographic cues alone less effective when compared to orthographic-and-phonological cue combinations? Five English-speaking monolinguals with post-stroke anomia completed a facilitation study, focusing on cued single spoken-word picture-naming. Linguistic unit (initial letter of the word vs. whole word) and cueing medium ('orthographic-only' vs. 'combined orthographic and phonological') were manipulated, with naming accuracy and response times (RTs) measured. Naming performance was evaluated at baseline and at two post-facilitation time points (15 min and 1 week post-facilitation). Three outcome measures-number of items accurately named as initial and final naming responses (accuracy scores), as well as RTs-were analysed for each participant, with effects of repeated exposure (if any) taken into account. Three participants significantly improved following whole word 'orthography-only' cues on at least one of the outcomes, whilst one participant improved following initial letter written-only cues. For 'combined orthographic-and-phonological' cues, two participants also benefitted when given the entire word, but none significantly improved with initial letter multimodal cueing. (1) This study provides case-level evidence on the efficacy of 'orthography-only' cues (both 'Initial letter' and 'Whole word' levels) to improve spoken naming, extending previously documented effects of a single application of a written cue to potentially 1 week later. This suggests a one-off application of a written cue could potentially be more durable than previously thought. (2) There is also evidence from two participants who benefitted from a combined orthographic-and-phonological cue, although these effects were comparatively short-lived. Taken together, these results caution a need to be sensitive to individuals' residual strengths/weaknesses post-stroke, rather than advocating the same strategy for all, including the indiscriminate use of multimodal cues. Our findings also provide a basis for further exploration of orthographic cueing as a therapeutic intervention for post-stroke word-finding deficits. What is already known on this subject Compared to research on other types of cues (e.g., semantic prompts), the literature on 'orthography only' cues is slim. Recent research, however, indicated that written cues are effective in treating word-finding difficulties. Outstanding questions remain, including the efficacy of different orthographic units and the corresponding duration of their effects. It is also unclear which language pathway(s) underpin(s) successful orthographic cueing. What this study adds The paper addresses gaps in our knowledge: (1) It provides fresh evidence to support the use of two units of orthographic prompts, that is, initial letter and whole word cues. (2) There is clarification that a single application of a written whole word can last for at least 1 week, which is a significant advancement from the previously evidenced duration of 10 min for written cues in general. (3) As far as we are aware, this study is the first in aphasiology that distinguishes and analyses naming accuracies of both initial and final responses. What are the clinical implications of this study? (1) Case-level data presented in this paper can be used by clinicians as references to gauge whether specific clients would best benefit from orthographic or combined orthographic-phonological cues. Understanding that an orthographic cue may have a durability of a week for a specific profile of individuals will also help clinicians develop more realistic intervention plans. All these are in keeping with efficient case management and evidence-based practice. (2) A reading task can determine who is able to rely on the multiple pathways to utilise an orthographic cue. To more effectively identify people with aphasia suitable for written-only cues, individuals may be screened on a reading-aloud task. (3) There is at least one participant who improved on naming through mere exposure to pictures without cueing, and this exposure was limited to a one-off encounter. Accounting for effects from repeated priming is thus necessary before one draws conclusions about the effects of cues on spoken word retrieval.

The purpose of this article is to orient both clinicians and researchers to machine learning (ML) approaches as applied to the field of speech-language pathology. We first introduce key ML concepts and terminology and proceed to feature exemplar papers of recent work utilizing ML techniques in speech-language pathology. We also discuss the limitations, cautions, and challenges to the implementation of ML and related techniques in speech-language pathology. Readers are introduced to broad ML concepts, including common ML tasks (e.g., classification, regression), and specific types of ML models (e.g., linear/logistic regression, random forest, support vector machines, neural networks). Key considerations for developing, evaluating, validating, and interpreting ML models are discussed. An application section reviews six exemplar published papers in the aphasiology literature that have utilized ML approaches. Lastly, limitations to the implementation of ML approaches are discussed, including issues of reliability, validity, bias, and explainability. We highlight emergent solutions and next steps to facilitate responsible and clinically meaningful use of ML approaches in speech-language pathology moving forward.

People with aphasia have an increased risk of developing symptoms of depression, anxiety, and chronic stress - all of which interfere with rehabilitation and limit functional outcomes. Interventions addressing the mental health needs of people with aphasia are critically important and rapidly emerging. Most self-rated questionnaires are highly language-dependent. It is unclear how aphasia researchers are managing this potential study limitation. To examine how treatment-induced changes in depression, anxiety, and chronic stress are currently being measured in people with stroke-induced aphasia and identify areas of concern and implications for future research. PsycINFO, CINAHL, PubMed, Embase, and Google Scholar were searched in February 2024. Key search terms included "depression", "anxiety", "chronic stress", "measurement", "aphasia", "stroke", and "treatment". Quantitative intervention studies reporting pre-post and/or group comparisons of depression, anxiety, or chronic stress, as either a primary or secondary outcome, with samples consisting of at least 50% of people with aphasia (or those reporting separate data for people with aphasia) were included in the review. Psychometric properties of the 10 most commonly used measures in the included studies were also evaluated. Thirty-six studies (out of 1518 screened) met inclusion criteria (13 randomized controlled trials; 23 non-randomized), from which 33 distinct measures were identified, including observer/clinician-rated (proxy), language-dependent self-rated, as well as visual scale/picture-supported measures. Most frequently used measures include the Stroke Aphasic Depression Questionnaire (SADQ-21 and SADQ-Hospital) and Visual Analog Mood Scale (VAMS) for depression; the Hospital Anxiety and Depression Scale - Anxiety subscale (HADS-A) for anxiety; the modified Perceived Stress Scale (mPSS) for chronic stress. Most significant treatment effects reported by studies were derived from measures with weak psychometric support for use with people with aphasia. Measures used to evaluate treatment-induced changes in depression, anxiety, and chronic stress in people with aphasia varied widely across studies. This variability may stem from a lack of validated measures available for this population and/or the absence of best practice recommendations for measuring mental health outcomes in people with aphasia. Given these limitations, caution is urged when interpreting treatment studies using current measures, and there is an urgent need for valid and reliable self-report measures specifically designed with and tested for people with aphasia.

Access, satisfaction, and affordability with healthcare services are critical to optimal health-related outcomes. These issues have not been traditionally considered in the study of people with aphasia (PWA). To assess healthcare access, satisfaction, and affordability among a nationally representative sample of PWA and compare wot stroke survivors without aphasia. Data from 404 PWA obtained from the 2019, 2020, 2021, and 2022 Medical Expenditure Panel Survey (MEPS) were used to examine ease of accessibility, satisfaction with healthcare, and affordability of healthcare and compared to stroke survivors without aphasia (N=4,120). Estimates indicated that, compared to their counterparts (stroke survivors without aphasia), PWA who were female (OR=1.1, CI=1.5, 2.4) and those earning low incomes (OR=1.9, CI=1.8, 4.4) were more likely to spend more than 15 minutes traveling to their usual source of care (USC). Hispanic PWA (OR=1.1, CI=1.2, 1.1), Black PWA (OR=1.5, CI=1.2, 1.6), and PWA living in the South (OR=3.4, CI=1.5, 2.4) were more likely to have difficulty contacting their USC by phone than the reference group. Hispanic (OR=1.5, CI=1.4, 1.6) and low income (OR=1.3, CI=1.1, 1.8) PWA had comparatively greater difficulty contacting their USC after hours. Additionally, Black (not explain OR=1.4, CI=1.1, 1.6; decide OR=1.4, CI=1.1, 1.9) and Hispanic (not explain OR=1.8, CI=1.6, 2.5; decide OR=1.3, CI=1.2, 1.3) PWA were more likely than Whites to feel that their provider did not explain all treatment options or ask them to help decide on their treatment. Finally, Black PWA (OR= 4.0, CI=1.3, 12.7) were more likely to have difficulty paying their medical bills than White PWA. No racial or ethnic differences in accessibility, satisfaction, or affordability appeared among those without aphasia. The study results indicate that PWA, particularly those from marginalized and low-income populations, may face additional barriers accessing healthcare, receive comparatively less satisfying care, and experience greater difficulty financing their healthcare.

Clinicians such as speech-language pathologists (SLPs) and neuropsychologists play a central role in the rehabilitation process of people with aphasia (PWA). Some studies, mostly from the Global North, have reported training, assessment, and treatment practices, as well as facilitators and barriers faced by clinicians working with PWA. However, less is known about these topics from the perspectives of clinicians working with PWA in the Global South. Understanding clinical practices in these countries can help to identify gaps in aphasia rehabilitation services and guide tailored implementation strategies to improve aphasia care in the Global South. This pilot study aims to contribute to this broader understanding by focusing on the experiences and perspectives of clinicians working with PWA in Colombia. The current pilot study had three aims, to: 1) describe the aphasia training received and the training needs perceived by SLPs and neuropsychologists working with PWA in Colombia; 2) report the assessment and treatment practices used when working with PWA in Colombia; and 3) outline the main facilitators and barriers to providing rehabilitation services to PWA in Colombia. Five SLPs and five neuropsychologists working with PWA in Colombia participated in this study. In-depth interviews were conducted to explore participants' training, assessment, treatment practices, and perceived facilitators and barriers to aphasia care. A thematic analysis was employed to identify key themes emerging from the interviews. Eleven key themes emerged from the thematic analysis. These themes were organized into four groups: training characteristics and resources, usual clinical practice characteristics in aphasia, facilitators of clinical practice, and barriers to clinical practice. Overall, clinicians perceived aphasia training to be insufficient. Perceived barriers included a lack of assessments and treatments adapted to the Colombian context, and Spanish-speaking patients. There were also barriers associated with the Colombian healthcare system, where some administrative processes hindered access and continuous rehabilitation services for PWA. Facilitators included some features of the universal healthcare system in Colombia and the ample number of qualified clinicians who could potentially work with aphasia. Our findings underscore the need to expand aphasia research in the Global South. Describing the training, assessment, and treatment practices, as well as systemic facilitators and barriers perceived by clinicians working with PWA in Colombia, is the first step toward understanding what implementation targets and strategies could meaningfully improve aphasia care in the country.

The field of human expert performance teaches us that high quality, high-dose guided practice is required to make large gains in cognitively driven acts. The same also seems to be true for people with acquired brain injury, yet therapy services for people with aphasia (PWA) have traditionally not been designed with this in mind. Intensive Comprehensive Aphasia Programmes (ICAPs) are one way to address the chronic under-dosing of therapy that most PWA experience. There are several ways to deliver an ICAP; here we describe two iterations of our Queen Square ICAP. There was a 20-month COVID-induced pause between the Year 1 (Y1) and Year 2 (Y2) ICAP groups. We analyse ICAP-induced changes in both groups of PWA on a series of key outcome measures that span the International Classification of Functioning, Disability and Health, covering language impairment and function as well as mood and social participation. Forty-six PWA took part in Y1 and 44 in Y2. The PWA were all in the chronic stage post stroke and varied in aphasia severity from mild to severe, with the Y2 group being more impaired than Y1. Quantitative data was collected before and after the ICAP. The Y2 therapy team provided independent reflections on their experiences of delivering an ICAP. ICAP-related changes in outcome measures (impairment, function and goal attainment) were generally comparable for the Y1 and Y2 groups, with both groups' speech production abilities improving the most. Both groups made clinically and statistically significant gains on the main quality of life measure. Participation in the ICAP made a big difference to PWAs' self-confidence ratings. Their mood ratings also improved significantly, although they were not, on average, in the depressed range at baseline (directly pre-ICAP). All improvements achieved in both groups were maintained at the 3-month follow-up, highlighting the lasting effects that ICAPs can provide. Evidence continues to accrue that ICAPs are an efficient way of increasing the dose of expert coaching required for people with chronic aphasia to make clinically meaningful improvements in their communicative abilities and quality of life. The main challenge remaining is convincing health-care providers to invest in them.

A greater amount of education is known to positively impact language skills in neurotypical populations, but its influence on language outcomes and recovery after stroke remains unclear. This study of 749 stroke survivors, with and without aphasia, investigated (A) which aphasia assessment tasks benefitted most from more pre-stroke education; and whether the effect of education (B) differs for aphasic and non-aphasic participants or other stroke and non-stroke-related variables, and/or (C) facilitates recovery from post-stroke aphasia. Participants ranged from one month to 42 years post-stroke. They were assessed using (i) the Comprehensive Aphasia Test (CAT), and (ii) self-report questionnaires that measured speech production, comprehension, reading, and writing at one week and one year post-stroke. Multiple regression analyses investigated the effect of education amount, and its interaction with other variables, on language outcomes and recovery. Bayesian statistics assessed the strength of the evidence for any observed effects. Many variables including lesion size, age at stroke, and initial severity were controlled for. (A) More years of formal education were associated with better overall language skills, with significant, albeit small effects found for semantic and letter fluency (β = 0.123 and 0.166) and spoken picture description, specifically, the number of words produced (β = 0.085) and grammatical well-formedness (β = 0.087). (B) The benefit of more pre-stroke education was mostly additive with the effects of other variables including initial aphasia severity and left hemisphere lesion size, but was reduced in older participants who had large lesions with severe initial symptoms. Finally, (C) no significant effect of education on language recovery was observed. More pre-stroke formal education is associated with higher post-stroke language scores on a wide range of tasks for both aphasic and non-aphasic participants, but, in participants with large lesions that cause severe aphasia, this advantage diminishes with age. These results suggest a generic benefit of education on language test performance rather than a specific role of pre-stroke education in aiding language outcomes and recovery. An individual's educational background should therefore be considered when interpreting assessment scores.

Speech language pathologists (SLPs) play a vital role in service delivery in post stroke aphasia. However, SLPs can potentially perpetuate health disparities due to 1) a lack of training regarding social determinants of health and how they contribute to clinical outcomes and associated disparities and 2) a lack of understanding of the rapidly evolving research related to equity of service provision needed to reduce or eliminate health disparities. This article provides recommendations for individual SLPs and the field more broadly to support health equity for people with aphasia and related disorders. We considered evidence-based practices from general healthcare to promote health equity and identified opportunities to apply these practices in the SLP field, focusing on the literature on racial inequities in post-stroke aphasia as an illustrative example. Lack of diversity in the workforce, lack of training in health disparities and methods to promote health equity, and lack of representation in research may contribute to inequities in healthcare for people with aphasia and other communication disorders. We identified eight recommendations for SLPs to promote health equity for people with aphasia and other communication disorders. SLPs should commit to a goal of equity in service delivery. This viewpoint provides actionable recommendations for clinicians, educators, and researchers, for promoting health equity for people with aphasia and related disorders.

To detect differences in speech fluency in separate primary progressive aphasia syndromes (PPA) using automated analysis techniques. The resulting linguistic features are evaluated for their use in a predictive model to identify common patterns in speakers with PPA. As fluency is observable in audio recordings, its quantification may provide a low-cost instrument that augments spontaneous speech analyses in clinical practice. Speech was recorded in 14 controls, 7 nonfluent variant (nfvPPA) and 8 semantic variant (svPPA) speakers. The recordings were annotated for speech and non-speech with Kaldi, a common toolkit for speech processing software. Variables relating to fluency (pause rate, number of pauses, length of pauses) were analyzed. The best fitting distribution of pause duration was a combination of two Gaussian distributions, corresponding with pause categories short vs. long.Group level differences were found in the rate of pauses and proportion of silence: nfvPPA speakers use more short pauses relative to long pauses than control speakers, and the duration of short and long pauses is longer; svPPA speakers use more longer pauses relative to short pauses. Their short pauses are significantly shorter than those from control speakers.Participants in both PPA groups pause more frequently. SvPPA speakers are typically perceived as fluent. However, our analysis shows their fluency patterns to be distinct from control speakers, if the long-short distinction is observed. Automatic measurements of pause duration show meaningful distinctions across the groups and might provide future aid in clinical assessment.