Northeastern University, Portland, ME.
University of Pittsburgh, PA.
J Speech Lang Hear Res. 2024 Sep 12;67(9):3094-3112. doi: 10.1044/2024_JSLHR-24-00030. Epub 2024 Aug 15.
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.
This study was a retrospective analysis of archival monologic discourse outcomes after intensive SFA for = 60 (Aim 1) and a subset = 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.
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.
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.
失语症患者将话语层面的交流（即语言的实际运用）视为治疗的首要重点。大多数失语症治疗的核心前提是，在语音、单词和/或句子层面恢复语言功能将泛化到话语层面。然而，与治疗相关的话语层面交流的变化是适度的，人们对其了解甚少，并且在不同的失语症患者之间差异很大。有鉴于此，本研究对两项高强度语义特征分析（SFA）临床试验中的档案、独白话语结果进行了多层次话语分析。目的 1 评估了理论上有动机的话语结果的变化，这些结果代表词汇语义处理、词汇多样性、语法复杂性和话语信息量。目的 2 探讨了非语言认知因素（语义记忆、分散注意力和执行功能）对话语结果的潜在调节作用。
本研究是对 60 名（目的 1）和 44 名（目的 2）接受高强度 SFA 治疗后的档案独白话语结果进行的回顾性分析。结果测量包括词汇语义处理（%语义错误）、词汇多样性（移动平均类型-令牌比）、语法复杂性（平均话语长度）和话语信息量（%正确信息单位）。贝叶斯广义混合效应模型用于检查四个研究时间点（入组、入组、出组和 1 个月随访）的变化。
本研究未发现 SFA 后使用标准、一般主题话语刺激测量时，独白话语表现有明显或统计学上可靠的改善。有微弱和不一致的证据表明，非语言认知因素可能在调节治疗反应方面发挥作用。
这些发现表明，明确需要将理论上有依据的旨在促进话语层面泛化的治疗方法与旨在捕捉话语层面的治疗方法相结合。此外，还需要研究现有的治疗方法，无论是恢复性治疗还是补偿性治疗，如何更好地促进话语层面的交流。这些重点对于有意义地改善日常交流和减少失语症的深远交流和心理社会后果至关重要。
