Manaswita Dutta, PhD, CCC-SLP: No financial or non-financial relationships to disclose
Abstract Evidence from acquired brain injury suggests an important role of extralinguistic cognitive skills in language abilities and functional communication outcomes. Persons with aphasia may frequently demonstrate deficits in cognitive skills (e.g., attention, memory, and/or executive functioning) and complex language processing, yet how cognitive deficits can influence functional communication and life participation outcomes among persons with aphasia has been nominally studied and warrants further empirical attention. Accordingly, this talk aims to review findings from two research studies examining: (1) the relationship between executive functions, spoken discourse abilities, and quality of life; and (2) the role of cognitive flexibility in communicative strategy use during spoken discourse production in persons with aphasia. Clinical and research implications will be discussed. Summary Background Previous research suggests a strong relationship between executive functions (EF) and spoken discourse in adults with and without brain injury (Cannizzaro & Coelho, 2013; Lê, et al., 2011). This relationship, however, has been insufficiently explored in persons with aphasia (PWA), even though they commonly demonstrate EF and spoken discourse deficits (Andreetta et al., 2012; Murray, 2017). Furthermore, impairments in EF skills including poor cognitive flexibility and problem solving have been associated with more frequent communication breakdowns and difficulties in switching to alternative modalities to successfully maintain conversations. Most existing studies have examined the link between EF and strategy use in limited aphasia profiles, using restricted cognitive and proxy communication measures (Purdy & Koch, 2006; Fridriksson et al., 2006). Importantly, given that impairments in cognitive and communication skills can hinder social participation and life satisfaction after brain injury (Cruice et al. 2010), the evaluation of the influence of EF and spoken discourse difficulties on aphasia-related quality of life (QOL) warrants attention. Aims The current study aimed to examine in PWA: (1) the integrity of their EF and spoken discourse abilities; (2) the relationship between their EF and spoken discourse performance; and (3) the influence of EF and discourse abilities on their life participation outcomes. A secondary analysis that was conducted to evaluate how frequently PWA utilized nonverbal communication modalities to supplement their verbal output during a spoken discourse task; and determine the link between their cognitive flexibility skills and alternative communication strategy use. Methods Twenty-two PWA (WAB-AQ mean=63.6, SD=9.3) and 24 age- and education-matched healthy controls (HC; MoCA mean=27, SD=1) participated (subset of HC n = 17 included for secondary analysis). Participants completed a comprehensive battery of verbal and non-verbal EF tests and retold the Bear and the Fly story. Additionally, PWA and their caregivers were administered assessments evaluating aphasia related QOL. Appropriate parametric and non-parametric statistical analyses were employed to compare group differences on EF, discourse, and communication strategy measures as well as to evaluate the relationship between EF, spoken discourse, and life participation variables. Results and Discussion Consistent with prior research (e.g., Boyle, 2009; Murray, 2017), PWA, compared to HC, demonstrated significantly less accurate and slower performances on most EF measures and significantly fewer correct information units (CIUs) and main concepts, reduced organization, more word retrieval errors, and less efficient language use. For PWA, macrolinguistic discourse performance correlated with inhibition (r=.572, p=.02), cognitive flexibility (r=.502, p=.04), and semantic fluency (r=.839, pr=.671, p=.02] and Sydney Psychosocial Reintegration Scale [SPRS-2; p=.662, p=.02] total scores). CIUs also correlated with ALA (r=.644, p=.02) and SPRS-2 (r=.662, p=.01). A significant relationship was also found between the SPRS-2 total score with main concepts (r=.594, p=.03) and overall macrolinguistic performance (r=.605, p=.03). The secondary study results indicated that PWA produced more meaning-laden (U=77, p=.001) and abstract gestures (U=65, p=.001) than HC during the story retell task (Stark & Cofoid, 2021). Individuals with more severe aphasia frequently supplemented their verbal output with gestures. More severe aphasia and poorer cognitive flexibility test scores were linked to more initiation of alternative modality switches during the discourse task, however, not all switches were successful. Conclusion The current study findings suggest that PWA demonstrate verbal and non-verbal EF and micro- and macrolinguistic spoken discourse difficulties, that can negatively affect their life participation and social reintegration. Further, results indicated a potential interaction between higher level EF skills and multimodal strategy use during spoken discourse; this relationship however may vary based on the task used. Overall, successful discourse production using verbal and nonverbal communication modalities among PWA are linked to their EF profiles. Thus, these findings support the need to address EF and spoken discourse in aphasia assessment and intervention, with the goal to improve functional communication and quality of life outcomes of PWA.
References Andreetta, S., Cantagallo, A., & Marini, A. (2012). Narrative discourse in anomic aphasia. Neuropsychologia, 50(8), 1787–1793. Boyle, M. (2009). Test-Retest Stability of Word Retrieval in Aphasic Discourse have. Journal of Speech, Language, and Hearing Research, 57, 966–978. Cannizzaro, M. S., & Coelho, C. A. (2013). Analysis of narrative discourse structure as an ecologically relevant measure of executive function in adults. Journal of psycholinguistic research, 42(6), 527-549. Cruice, M., Hill, R., Worrall, L., & Hickson, L. (2010). Conceptualizing quality of life for older people with aphasia. Aphasiology, 24(3), 327–347. Fridriksson, J., Nettles, C., Davis, M., Morrow, L., & Montgomery, A. (2006). Functional communication and executive function in aphasia. Clinical linguistics & phonetics, 20(6), 401-410. Lê, K., Mozeiko, J., & Coelho, C. (2011). Discourse analyses: Characterizing cognitive-communication disorders following TBI. The ASHA Leader, 16(2), 18-21. Marini, A., Galetto, V., Zampieri, E., Vorano, L., Zettin, M., & Carlomagno, S. (2011). Narrative language in traumatic brain injury. Neuropsychologia, 49, 2904–2910. Murray, L. L. (2017). Design fluency subsequent to onset of aphasia: A distinct pattern of executive function difficulties? Aphasiology, 31(7), 793–818. Purdy, M., & Koch, A. (2006). Prediction of strategy usage by adults with aphasia. Aphasiology, 20(02-04), 337-348. Stark, B. C., & Cofoid, C. (2022). Task-specific iconic gesturing during spoken discourse in aphasia. American Journal of Speech-Language Pathology, 31(1), 30-47.
Learning Objectives:
At the completion of this activity, participants should be able to:
At the end of the session, attendees will be able to describe the importance of assessing executive functioning in persons with chronic aphasia and select time-efficient tools to evaluate verbal and nonverbal executive functions in this clinical population.
At the conclusion of this session, attendees will be able to explain the importance of targeting spoken discourse in aphasia rehabilitation.
At the conclusion of this session, attendees will be able to summarize the role of cognitive functions (e.g., executive functioning) in spoken discourse and functional communication outcomes, as well as the impact of such cognitive-linguistic difficulties on aphasia-related quality of life.