Profiling text comprehension impairments in aphasia

Abstract

Background: Research in aphasia has focused on acquired dyslexias at the single word level, with a paucity of assessment techniques and rehabilitation approaches for individuals with difficulty at the text level. A rich literature from research with paediatric populations and healthy non-brain damaged, skilled adult readers allows the component processes that are important for text reading to be defined and more appropriate assessments to be devised. Aims: To assess the component processes of text reading in a small group of individuals with aphasia who report difficulties in reading at the text level. Do assessments of component processes in reading comprehension reveal distinct profiles of text comprehension? To what extent are text comprehension difficulties caused by underlying linguistic and/or cognitive deficits? Methods & Procedures: Four individuals with mild aphasia who reported difficulties in reading at the text level took part in a case-series study. Published assessments were used to confirm the presence of text comprehension impairment. Participants completed a range of assessments to provide a profile of their linguistic and cognitive skills, focusing on processes known to be important for text comprehension. We identified the following areas for assessment: reading speed, language skills (single word and sentence), inferencing, working memory and metacognitive skills (monitoring and strategy use). Outcomes & Results: Performance was compared against age-matched adult control data. One participant presented with a trend for impaired abilities in inferencing, with all other assessed skills being within normal limits. The other three had identified linguistic and working memory difficulties. One presented with a residual deficit in accessing single word meaning that affected text comprehension. The other two showed no clear link between sentence processing difficulties and text comprehension impairments. Across these three, data suggested a link between verbal working memory (VWM) capacity and specific inferencing skills. Conclusions: Successful text reading relies on a number of component processes. In this paper we have made a start in defining those component processes and devising tasks suitable to assess them. From our results, assessment of VWM and inferencing appears to be critical for understanding text comprehension impairments in aphasia. It is possible that rehabilitation input can capitalise on key meta-cognitive skills (monitoring, strategy use) to support functional reading in the face of existing linguistic, text comprehension and memory impairments.

"The brain can't cope": Insights about reading from people with chronic aphasia

“…There has now been more investigation of paragraph level reading, which is a closer approximation to everyday reading. Research has examined the nature of the reading difficulties, with characterisation of the influence of different types of information (Brookshire & Nicholas, 1993;Meteyard, Bruce, Edmundson, & Oakhill, 2015;Webster, Morris, Howard, & Garraffa, 2018) and the relationship between reading and other cognitive skills, for example, memory and executive function (Chesneau & Ska, 2015;Meteyard et al, 2015). Treatment studies at paragraph level have considered the impact of training oral reading or teaching various reading strategies on reading speed and reading comprehension (see Watter, Copley, & Finch, 2016 for a review of treatment for reading difficulties following acquired brain injury, including aphasia).…”

“…There is extensive variability in normal adults in the importance of reading, reading ability and preferences (Parr, 1992). Parr found that literacy activities (reading and writing) vary with a person's social network and roles, with delegation of some tasks to other people.…”

“…Parr found that literacy activities (reading and writing) vary with a person's social network and roles, with delegation of some tasks to other people. Literacy activities cannot be predicted or typified (Parr, 1992), emphasising the need to explore pre-morbid reading when considering the impact of aphasia on reading. Over recent years, there has been an increasing reliance on technology to perform traditional reading and writing tasks (Dietz, Ball, & Griffith, 2011) and the Internet is used extensively for communication (Menger, Morris, & Salis, submitted).…”

Effects of word frequency and contextual predictability on sentence reading in aphasia: an eye movement analysis

“…Cocks, Pritchard, Cornish, Johnson, & Cruice, 2013;Coelho, 2005;Meteyard, Bruce, Edmundson, & Oakhill, 2015). The reasons for reading difficulties can be myriad, as successful reading is based on the accurate and timely interplay of visual, linguistic and cognitive processes.…”

Treating reading comprehension deficits in sub-acute brain injury rehabilitation: Identifying clinical practice and management

“…Typically, pwABI experience discourse or text level reading comprehension deficits (i.e., occurring at a paragraph level or above) in the context of a cognitive-communication disorder (CCD) 14,15 , however these deficits may also occur following aphasia 16 . A recent systematic review investigated discourse level reading comprehension difficulties following ABI 17 .…”