Assessment tools and rehabilitation treatments for aprosodia following acquired brain injury: A scoping review

Abstract

Background Acquired brain injury (ABI), especially to the right hemisphere, can result in difficulty using or understanding prosodic contours in speech. Prosody is used to convey emotional connotation or linguistic intent and includes pitch, loudness, rate, and voice quality. A disorder in the comprehension or production of prosody is known as aprosodia; despite the communication disability caused by prosodic disorders, the assessment and treatment of aprosodia following ABI has received scant attention. Aims The aim of this scoping review is to gather and synthesise useful knowledge on aprosodia and provide therapists with an exhaustive document in order to guide clinical decision‐making encouraging active identification and treatment of this disorder. Methods & Procedures This scoping review, conducted in accordance with PRISMA‐ScR guidelines, investigated the existing literature concerning the assessment and treatments of linguistic and affective aprosodia in adult patients after ABI. A systematic search in four electronic databases (PubMed, CINAHL, Web of Science, ScienceDirect) was conducted for articles written in English, French, or Italian published between 1970 and 2020. After all evaluative criteria were applied, 15 articles were included for final review. Outcomes & Results Results show the presence of six assessment tools for affective aprosodia and five evaluation tools targeting affective and linguistic prosody. Assessment of aprosodia is generally accomplished through acoustic and perceptual approaches. Current treatments for prosodic disorders focus on expressive aprosodia and have applied mostly two different approaches: imitative and cognitive–linguistic methods. Conclusion & Implications Findings suggest that aprosodia can be assessed by therapists through various techniques and may be amenable to behavioural treatments. Nevertheless, although there are several assessment tools available, no one currently offers a comprehensive assessment that incorporates an ecological dimension. It therefore seems necessary to continue research in this direction. The rehabilitation of receptive prosody abilities also remains to be explored. What this paper adds What is already known on the subject Prosody has a fundamental role in communication and conveys speakers’ intentions and emotions. Therefore, a deficit of prosody (aprosodia) after acquired brain injury can reduce social participation and engagement. Assessment tools and rehabilitation treatments are necessary in order to improve this disorder and patients’ quality of life. What this paper adds to existing knowledge The evaluation tools currently available focuses mostly on affective aprosodia, whereas the linguistic prosody is less assessed. There exist two treatments for expressive aprosodia: motoric–imitative and cognitive–linguistic treatments; however, their efficacy is tested on small groups of patients. No treatments targeting receptive aprosodia were found. What are the potential or actual clinical implications of this work? We ne...

Separating representational and noise components of speech prosody perception after stroke

“…An oft-quoted limitation of the MEC instrument is its poor sensitivity, with patients above the pathological cut-off on the MEC prosody comprehension scale (9/12) still complaining of communication difficulties 5 . Interestingly, our measures allowed clear separation of this group of MEC-negative patients (N=12/22) and controls (N=12), both in terms of typicality of representation (M=-0.18 [-0.32 – -0.06], U(-0.68)=23.0, p=.005) and internal noise (M = 1.71 [0.71, 2.83], U(-0.7)=71,p=0.014).…”

“…19) in the range of those typically observed for lower-level auditory and visual tasks 9 (Figure 2-right). In contrast, patients' internal representations had both lower amplitude (indicating less discriminative power) and more variable shape across individuals (Figure 2-left; see also Figure 3), and were applied with higher levels of internal noise (M=2.57, SD=1.93; Figure 2 An oft-quoted limitation of the MEC instrument is its poor sensitivity, with patients above the pathological cut-off on the MEC prosody comprehension scale (9/12) still complaining of communication difficulties 5 . Interestingly, our measures allowed clear separation of this group of Finally, to examine the convergent validity and specificity of internal representation and internal noise measures, we investigated whether they were statistically associated with other constructs linked to central deficits common in stroke rehabilitation.…”

“…Despite the social-cognitive implications for patients of not being able to process e.g. emotional or attitudinal expressions 4 , aprosodia following stroke has received scant attention: first, existing assessment tools based on simple perceptive tasks are insufficiently sensitive; second, we lack mechanistic understanding of why patients perform poorly on such tasks and therefore lack practical therapeutic targets for their subsequent rehabilitation 5 .…”

Affective prosody disorders in adults with neurological conditions: A scoping review

“…Most studies used experimental tasks to assess affective prosody, leading to heterogeneity in the assessment methods reported in the literature. The few standardised tools identified in the included studies are mostly published in English (for a recent review on prosody assessment in adults, see Benedetti et al., 2021). Moreover, the assessment tasks typically used in affective prosody research are not explicitly designed to test each stage of affective‐prosodic processing (i.e., perceptual, representational, semantic and sensorimotor processes), but to test the general comprehension or production of affective prosody.…”

“…The limited knowledge about the clinical groups at risk for affective‐prosodic deficits complicates the identification and treatment of affective prosody disorders in clinical settings (Hawthorne & Fischer, 2020). Despite the harmful impact of affective‐prosodic deficits on patients’ everyday lives, affective prosody is still rarely addressed in clinical settings and the assessment and rehabilitation of affective‐prosodic deficits are not done routinely by clinicians (Benedetti et al., 2021; Hawthorne & Fischer, 2020). Raising awareness of the potential for these difficulties in numerous clinical groups should improve the recognition of affective‐prosodic deficits in clinical settings.…”