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How do clinicians judge fluency in aphasia? (Gordon & Clough, 2022)

journal contribution
posted on 2022-03-10, 17:38 authored by Jean K. Gordon, Sharice Clough
Purpose: Aphasia fluency is multiply determined by underlying impairments in lexical retrieval, grammatical formulation, and speech production. This poses challenges for establishing a reliable and feasible tool to measure fluency in the clinic. We examine the reliability and validity of perceptual ratings and clinical perspectives on the utility and relevance of methods used to assess fluency.
Method: In an online survey, 112 speech-language pathologists rated spontaneous speech samples from 181 people with aphasia (PwA) on eight perceptual rating scales (overall fluency, speech rate, pausing, effort, melody, phrase length, grammaticality, and lexical retrieval) and answered questions about their current practices for assessing fluency in the clinic.
Results: Interrater reliability for the eight perceptual rating scales ranged from fair to good. The most reliable scales were speech rate, pausing, and phrase length. Similarly, clinicians’ perceived fluency ratings were most strongly correlated to objective measures of speech rate and utterance length but were also related to grammatical complexity, lexical diversity, and phonological errors. Clinicians’ ratings reflected expected aphasia subtype patterns: Individuals with Broca’s and transcortical motor aphasia were rated below average on fluency, whereas those with anomic, conduction, and Wernicke’s aphasia were rated above average. Most respondents reported using multiple methods in the clinic to measure fluency but relying most frequently on subjective judgments.
Conclusions: This study lends support for the use of perceptual rating scales as valid assessments of speech-language production but highlights the need for a more reliable method for clinical use. We describe next steps for developing such a tool that is clinically feasible and helps to identify the underlying deficits disrupting fluency to inform treatment targets.

Supplemental Material S1. Survey instrument.

Supplemental Material S2. Checklist for Reporting Results of Internet E-Surveys (CHERRIES; Eysenbach, 2004).

Supplemental Material S3. Final set of PwA from AphasiaBank (see text for details).

Supplemental Material S4. Intercorrelations among the perceptual rating scales.

Supplemental Material S5. Statistical comparisons of dimensions used (top) and importance assigned to dimensions (bottom) by different subsets of respondents (Analysis 3a). Significant effects are shown in bold.

Gordon, J. K., & Clough, S. (2022). How do clinicians judge fluency in aphasia? Journal of Speech, Language, and Hearing Research. Advance online publication.


This work was generously supported by a New Century Scholar grant from the American Speech-Language- Hearing Foundation.