Background: Individuals with acquired apraxia of speech (AOS) can lose precision of articulatory movements, including the ability to achieve correct production of specific sounds or sound sequences. Novel treatment approaches should be explored to enhance treatment outcomes. Aims: To evaluate the clinical feasibility of ultrasound visual feedback of the tongue for addressing errors on rhotics in a patient with AOS. Ultrasound visual feedback was used to provide knowledge of performance to the participant. Methods & Procedures:A multiple baseline single case report is presented to evaluate a treatment programme that uses visual feedback of the participant's tongue from realtime ultrasound images. A blocked practice schedule was implemented during 12 onehour therapy sessions; 30 minutes involved ultrasound visual feedback (10 minutes of pre-practice and 20 minutes of practice) and 20 minutes involved non-ultrasound practice. Cues were provided to modify tongue shape to achieve perceptually accurate production of rhotics, along with practice trials with increasing levels of phonetic complexity. The feedback type (verbal knowledge of performance and knowledge of results) and feedback frequency (number of trials with feedback) were structured to adhere to principles of motor learning. Outcomes & Results:The participant demonstrated moderate evidence of acquisition of prevocalic rhotics and strong evidence of acquisition of postvocalic rhotics during treatment. There was evidence of retention and generalisation only for postvocalic rhotics. An untreated context was probed regularly and showed no evidence of improvement. Conclusion:The results provide preliminary support for the feasibility of this treatment approach for improving speech accuracy in adults with acquired AOS. The improvements in stimulability for the treated sound sequences could be used to foster further motor learning.

Purpose The purpose of this study was to determine whether the correct information unit (CIU) can be reliably applied to unstructured conversational discourse in people with aphasia (PWA). The CIU was developed by Nicholas and Brookshire (1993) to measure word-level informativeness in structured monologue-level discourse and is widely used by clinicians and researchers for this purpose. A case study ( Oelschlaeger & Thorne, 1999 ) investigating the use of the CIU in conversation has suggested potential issues with interrater reliability (IRR), which has discouraged application of the CIU to this discourse context. However, no further research has been conducted to replicate or extend this finding. Given a clinical and research need for reliable linguistic measures appropriate for use in unstructured conversation, revisiting the reliability, stability, and suitability of the CIU is indicated. Method The CIU protocol developed by Nicholas and Brookshire (1993) was modified according to the needs of conversational discourse, resulting in the CIU in conversation (CIUconv) protocol. Two speech-language pathology graduate student research assistants completed training on use of the CIUconv with the 1st author. Sixteen conversations held by 8 PWA (i.e., 2 conversations each) were used as language samples to determine IRR of percent CIU (%CIU) in conversation through use of the CIUconv. Test–retest stability of %CIU as applied per this protocol was then assessed across the 2 conversations collected for each PWA. Results Use of the CIUconv resulted in excellent IRR of %CIU for each research assistant and the 1st author. Likewise, test–retest stability for the measure was excellent. Results were evaluated at both the group and individual levels. Conclusions %CIU demonstrated excellent interrater and test–retest reliability when applied to unstructured conversation using the CIUconv procedure, which was developed to account for expected linguistic characteristics of conversation. These findings suggest that %CIU may be a feasible, reliable measure of informativeness in unstructured conversation in PWA when the CIUconv is used by trained raters.

Purpose The aim of this study was to determine if people with aphasia demonstrate differences in microlinguistic skills and communicative success in unstructured, nontherapeutic conversations with a home communication partner (Home-P) as compared to a speech-language pathologist communication partner (SLP-P). Method Eight persons with aphasia participated in 2 unstructured, nontherapeutic 15-minute conversations, 1 each with an unfamiliar SLP-P and a Home-P. Utterance-level analysis evaluated communicative success. Two narrow measures of lexical relevance and sentence frame were used to evaluate independent clauses. Two broad lexical and morphosyntactic measures were used to evaluate elliptical and dependent clauses and to evaluate independent clauses for errors beyond lexical relevance and sentence frame (such as phonological and morphosyntactic errors). Utterances were further evaluated for presence of behaviors indicating lexical retrieval difficulty (pauses, repetitions, and false starts) and for referential cohesion. Results No statistical differences occurred for communicative success or for any of the microlinguistic measures between the SLP-P and Home-P conversation conditions. Four measures (2 of lexical retrieval and 1 each of communicative success and grammaticality) showed high correlations across the 2 conversation samples. Individuals showed variation of no more than 10 percentage points between the 2 conversation conditions for 46 of 56 data points. Variation greater than 10 percentage points tended to occur for the measure of referential cohesion and primarily for 1 participant. Conclusions Preliminary findings suggest that these microlinguistic measures and communicative success have potential for reliable comparison across Home-P and SLP-P conversations, with the possible exception of referential cohesion. However, further research is needed with a larger, more diverse sample. These findings suggest future assessment and treatment implications for clinical and research needs. Supplemental Material https://doi.org/10.23641/asha.7616312

Purpose This study evaluated interrater reliability (IRR) and test–retest stability (TRTS) of seven linguistic measures (percent correct information units, relevance, subject–verb–[object], complete utterance, grammaticality, referential cohesion, global coherence), and communicative success in unstructured conversation and in a story narrative monologue (SNM) in persons with aphasia (PWAs) and matched participants without aphasia (M-PWoAs). Furthermore, the relationship of language in unstructured conversation and SNM was investigated for these measures. Methods Twenty PWAs and 20 M-PWoAs participated in two unstructured conversations on different days with different speech-language pathologists trained as social conversation partners. An 8- to 12-min segment of each conversation was analyzed. Additionally, a wordless picture book was used to elicit an SNM sample at each visit. Correlational analyses were conducted to address the primary research questions. Normative range and minimal detectable change data were also calculated for the measures in both conditions. Results IRR and TRTS were moderate to good for parametric measures and moderate to excellent for nonparametric measures for both groups, except for TRTS for referential cohesion for the PWAs in conversation. Furthermore, in PWAs, a strong correlation was demonstrated for three of eight measures across conditions. Moderate or weaker correlations were demonstrated for three of eight measures, and correlations for two of eight measures were not significant. An ancillary finding was no significant differences occurred for sample-to-sample variability between the two conditions for any measure. Conclusions This study replicates previous research demonstrating the feasibility to reliably measure language in unstructured conversation in PWAs. Furthermore, this study provides preliminary evidence that language production varies for some measures between unstructured conversation and SNM, contributing to a literature base that demonstrates language variation between different types of monologue. Thus, these findings suggest that inclusion of the specific types of discourse of interest to the PWA may be important for comprehensive assessment of aphasia. Supplemental Material https://doi.org/10.23641/asha.16569360

Purpose In this article, we draw a parallel between the experience of social isolation that occurred throughout the world during the Coronavirus Disease 2019 pandemic and similar experiences occurring in everyday life for people with communication disorders living in long-term care (LTC) facilities. We propose that speech-language pathologists can use the widespread experience of social isolation as a learning catalyst in the effort to shift the LTC culture to one that more highly values a communicative environment that is accessible to all, thereby reducing risk of social isolation for those with communication disorders. Conclusions Many training paradigms for promoting an accessible communicative environment are available in the speech-language pathology literature, yet institutional barriers exist for their widespread implementation. Overcoming these barriers is a challenge that requires awareness and learning on the part of staff and administration regarding the impact of an unfriendly communicative environment on social isolation, and the resulting psychosocial consequences. Learning theory indicates that new learning in adults is motivated by connections between personal experiences and the material to be learned. Explicitly infusing established training programs with the experience of social isolation brought on by the Coronavirus Disease 2019 pandemic may be the key needed for changing the communicative environment in LTC.