Integrated narrative analysis in multilingual aphasia: The relationship among narrative structure, grammaticality, and fluency

Abstract

Background: Amid robust evidence for the efficacy of language treatment in aphasia, equivocal results have been reported for the generalisation of treatment effects to items and tasks not practised during therapy. Moreover, measuring generalisation using functional language production has proven challenging, especially in the context of multilingual aphasia. Aim: In this paper we analysed four domains-discourse structure, sentence structure, instances of linguistic dysfluencies, and lexical choice-in narratives produced following treatment to assess aphasia treatment generalisation within and across languages. Methods & Procedures: Two treatment phases were administered to a trilingual speaker with mild, chronic, non-fluent aphasia, targeting language production. Multiple baseline testing was administered prior to and following each treatment phase and included elicited narrative production in three languages: Hebrew, English, and French. Outcomes & Results:The results demonstrated treatment-related changes in the treated language as well as in the non-treated languages. Positive change was found in narrative structure and in sentence grammaticality. A trade-off pattern between grammaticality and fluency was evident, with higher proportions of grammatical sentences associated with increased instances of linguistic dysfluencies. Within-language and between-language generalisation was observed, especially following the first treatment phase which targeted morphosyntactic structures. Conclusions: We argue for the importance of an integrated analysis of connected language production in the assessment of aphasia treatment efficacy and in multilingual aphasia.

Reviewing the quality of discourse information measures in aphasia

“…For example, in the category of ‘story grammar’, some measures described narrative discourse (Altman et al . , Coelho et al . , Li , Olness et al .…”

The role of language proficiency and linguistic distance in cross-linguistic treatment effects in aphasia

“…As well, the untreated French (L3) demonstrated improved grammatical accuracy, for example, increased correct use of prepositions and pronouns, but not on other measures, including article use and speech rate in sentence production (Goral, Levy, and Kastl, 2010). Moreover, morphosyntactic measures at the sentence level did not show change in his other untreated language, his L1 Hebrew, while other measures of connected speech production, such as sentence grammaticality and narrative structure, did (as reported in Altman, et al, 2012). Similarly, Knoph, Lind, and Simonsen (2015) treated a multilingual speaker in her late-learned (L4) Norwegian and found mixed evidence for cross-language generalisation to her other languages; for example, gains were noted in her earlier-learned English (L2) in semantic and syntactic subtests of the Bilingual Aphasia Test (BAT; Paradis and Libben, 1987), but not in verb naming nor on sentence and discourse variables in connected speech production.…”

“…It is also common for such treatment studies to report cross-language generalisation in some, but not all, outcome measures (e.g. Altman, Goral, and Levy, 2012; Laganaro and Overton-Venet, 2001), to some, but not all, untreated languages (e.g. Goral, Rosas, Conner, Maul, and Obler, 2012; Knoph, Lind, and Simonsen, 2015; Miertsch, Meisel, and Isel, 2009) and ---for studies that report on several bilingual participants---to find the generalisation in some, but not all, participants (e.g.…”

“…Few studies have reported untreated aspects, such as overall test scores and severity levels (e.g. Knoph, 2013; Miller Amberber, 2012), or generalisation to connected speech production (Altman et al, 2012; Knoph et al, 2015). Particularly little is known about change in overall efficiency of language production, especially in mild aphasia, among bilingual individuals.…”

Transcranial Direct-Current Stimulation May Improve Discourse Production in Healthy Older Adults

“…The aim of this study was to investigate the effect of anodal tDCS on discourse production and optimal electrode placement for the enhancement of language at this level in healthy older speakers. Several discourse measures were used as this is encouraged in aphasia research in order to gain a comprehensive analysis at the level of discourse speech and identify areas of strength in discourse output ( 20 , 68 , 69 ). Overall, the results demonstrate a greater number of significant within-group language modulations for both anodal tDCS conditions compared to sham, where the greatest improvements in language performance were noted for LIFG stimulation.…”