Assessing conversation and narrative in aphasia (Leaman & Edmonds, 2021)

Purpose: This study evaluated interrater reliability (IRR) and test–retest stability (TRTS) of seven linguistic measures (percent correct information units, relevance, subject–verb–[object], complete utterance, grammaticality, referential cohesion [REF], global coherence), and communicative success in unstructured conversation and in a story narrative monologue (SNM) in persons with aphasia (PWAs) and matched participants without aphasia (M-PWoAs). Furthermore, the relationship of language in unstructured conversation and SNM was investigated for these measures.

Methods: Twenty PWAs and 20 M-PWoAs participated in two unstructured conversations on different days with different speech-language pathologists trained as social conversation partners. An 8–12-min segment of each conversation was analyzed. Additionally, a wordless picture book was used to elicit an SNM sample at each visit. Correlational analyses were conducted to address the primary research questions. Normative range and minimal detectable change data were also calculated for the measures in both conditions.

Results: IRR and TRTS were moderate to good for parametric measures and moderate to excellent for nonparametric measures for both groups, except for TRTS for REF for the PWAs in conversation. Furthermore, in PWAs, a strong correlation was demonstrated for three-eighths measures across conditions. Moderate or weaker correlations were demonstrated for three-eighths measures, and correlations for two-eighths measures were not significant. An ancillary finding was no significant differences occurred for sample-to-sample variability between the two conditions for any measure.

Conclusions: This study replicates previous research demonstrating the feasibility to reliably measure language in unstructured conversation in PWAs. Furthermore, this study provides preliminary evidence that language production varies for some measures between unstructured conversation and SNM, contributing to a literature base that demonstrates language variation between different types of monologue. Thus, these findings suggest that inclusion of the specific types of discourse of interest to the PWA may be important for comprehensive assessment of aphasia.

Supplemental Material S1. Story Narrative Monologue Instructions Script and Summary of Stimulus Book, “Picnic.”

Supplemental Material S2. Story Narrative Monologue Exemplar for Participants: “Chalk” (Thomson, 2010).

Supplemental Material S3. Utterance Designator Codes Used During Transcription to Indicate Which Measures Should Be Applied.

Supplemental Material S4. Group Age Differences.

Supplemental Material S5. Mean Length of Utterance, Type-Token Ratio, and Percent Incomplete Utterances for People With and Without Aphasia in Both Discourse Conditions.

Supplemental Material S6. Conversation and Story Narrative Monologue Samples for Three Participants.

Supplemental Material S7. M-PWoA: Group Discourse Data for Visit 1.

Supplemental Material S8. People With Aphasia: Individual Data for Each Measure in Conversations 1 and 2.

Supplemental Material S9. People With Aphasia: Individual Data for Each Measure in Story Narrative Monologues 1 and 2.

Supplemental Material S10. Group Data for People With Aphasia for Binary Measure in Each Condition.

Supplemental Material S11. Group Data for People With Aphasia for 4-Point Scale Measures in Each Condition.

Leaman, M. C., & Edmonds, L. A. (2021). Assessing language in unstructured conversation in people with aphasia: Methods, psychometric integrity, normative data, and comparison to a structured narrative task. Journal of Speech, Language, and Hearing Research. Advance online publication. https://doi.org/10.1044/2021_JSLHR-20-00641