Text comprehension in residual aphasia after basic-level linguistic recovery: a multiple case study

Abstract

Background: Text comprehension entails a complex interaction between cognitive and linguistic factors. In aging, text comprehension depends on text characteristics, particularly semantic load.Persons with residual aphasia may complain of discourse comprehension difficulties without linguistic problems. Three levels of representation are involved in text comprehension (surface level, semantic level constituted by macrostructure and microstructure, and situational level).Attention, verbal working memory, long-term memory, and executive functions combine to allow processing of all levels of representation. Aims:The primary objectives of this multiple case study were (a) to examine microstructure, macrostructure and situational model updating in text comprehension in five participants with left-brain-damage (PWLBD), who continued to complain about problems with discourse comprehension without linguistic problems, and (b) to examine executive function and memory in these participants.Methods and procedure: Five PWLBD were selected for the study. We asked the participants to read and understand three narrative texts. The texts varied according to semantic load (the amount of information). In each text, we assessed macrostructure, microstructure and situational model updating. To evaluate memory and executive functions, we administered specific complementary tasks. Results were compared to normative data obtained from a previous study with a total of 60 neurologically intact control participants, divided into younger (N = 30) and older (N = 30) groups. Outcomes and results:The results for the five PWLBD indicated that text comprehension is influenced by text characteristics, particularly semantic load; the findings demonstrated shortterm memory and cognitive flexibility deficits. Text comprehension in residual aphasia 3Conclusions: These findings have two major implications. Analysing text comprehension using several texts with varying semantic loads is a promising tool for diagnosing residual aphasia and for designing specific cognitive interventions that target reading comprehension abilities in persons with residual aphasia.

"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).…”

Reading for Meaning: What Influences Paragraph Understanding in Aphasia?

“…Impaired verbal working memory (as assessed by pointing span) was, however, associated with difficulty with global inferences. Chesneau and Ska (2015), in a study of five individuals with aphasia, also investigated the impact of attentional and memory demands, but found no straightforward relationship between cognitive performance and patterns of text comprehension. Their study considered the impact of semantic load (number of details) and the extent to which people had to modify and update their understanding of a situation they were reading about e.g., they would read a passage about plane crash which they may subsequently read was in a dream.…”

“…In summary, extensive variability has been seen in people with aphasia in terms of reported reading difficulty (Knollman-Porter et al, 2015;Parr, 1995;Samouelle, 2013), the difficulties seen on tests of reading comprehension (Meteyard et al, 2015;Webster et al, 2013) and the relationship between reading comprehension and relevant cognitive skills (Chesneau & Ska, 2015;Meteyard et al, 2015). We need to further understand reading comprehension at paragraph/discourse level as this level of comprehension is related to everyday reading activities, for example, reading short newspaper/magazine articles, instructions and personal correspondence, and is a step towards developing our understanding of how we comprehend and integrate information across longer texts e.g., books.…”

“…When reading extended text, ideas build over time and within a book or newspaper article, readers need to attach certain information or themes to particular characters. This may relate to the notion of updating the situational model (as investigated by Chesneau & Ska, 2015); as readers understand each paragraph, they must extract the key information and associate that key information with the characters and then as they read additional paragraphs, they must add extra information or change their situational model about the characters. There has been no attempt to study this type of information within previous studies of reading comprehension or reading assessments used with people with aphasia.…”

Efficacy of a strategy-based intervention on text-level reading comprehension in persons with aphasia: a study protocol for a repeated measures study

“…In PWA, on the one hand, cognitive resources such as verbal working memory, episodic memory, monitoring and cognitive flexibility may be impaired. 15 16 On the other hand, receptive and productive language skills can be affected to various degrees. 16 17 Even though general aphasia tests (which often assess phonology, morphology or syntax) may detect only minor or no difficulties, PWA may encounter substantial problems in text comprehension, including a reduced reading speed.…”