Aphasia is a language expression or comprehension impairment associated with strokes and other acquired brain injuries. It often results in chronic reading comprehension problems. Given society's increasing reliance on written communication, aphasia-based reading problems have profound negative effects on quality of life. Existing restorative treatments have not been effective in helping people with aphasia resume reading for functional purposes or personal enjoyment. Likewise, treatments have not eliminated the dependence of people with aphasia on others to decode, interpret, or modify written materials. Our project, entitled Strategies to Accommodate Reading (STAR), will allow us to explore the effectiveness of text-to-speech (TTS) conversion systems in helping people with aphasia read independently. TTS systems provide simultaneous auditory and written output of text. Existing data suggest people with aphasia often understand spoken utterances better than written sentences and benefit from having information presented in more than one modality. Hence, using TTS systems is likely to promote improved comprehension. To date, no formal research exists about using TTS technology to help people with aphasia read paragraph-length materials; also, no studies exist about the social acceptance of TTS technology. Our goal is to test the effectiveness of using and adjusting key TTS features to help people with aphasia independently read everyday texts of interest and value to them. We will also explore aspects of the social validity of TTS in relation to acceptance and use.
Our aims target the identification of variables determining intervention effectiveness.
In Aim 1, we will evaluate for whom and to what extent TTS support improves comprehension of paragraph-length material by people with various types and severities of aphasia.
In Aim 2, we will determine user preferences and evaluate comprehension benefits provided by varying key TTS system features (i.e., speech rate, text highlighting options, speech production options).
In Aim 3, we will perform initial social validity assessments with a specific objective of establishing guidelines for matching the technology to potential users. Our work will provide practitioners with evidence-based guidelines for using TTS systems with people with aphasia, thus promoting effective design and application of a new intervention strategy for addressing chronic reading challenges. The implementation plan will also enhance the educational and research environments of Miami and Duquesne Universities by promoting student research involvement; providing opportunities for students to refine clinical skills; providing students with valuable examples of clinically-based research; and encouraging rich interactions among students, clinical faculty, and research faculty.

Public Health Relevance

Approximately 795,000 people sustain cerebrovascular accidents (CVAs) each year in the United States (1), with about 40% of them exhibiting the characteristics of aphasia as a result (2). In all, about 1 million Americans currently live with aphasia-related communication challenges (3). Due to the multimodal nature of acquired communication disorders, most people with aphasia have associated reading challenges; however, precise data do not exist stipulating the frequency with which people with aphasia struggle with literacy. Researchers have established, however, that 23.2% of all people sustaining CVAs report subsequent reading difficulties (4). When considering only those experiencing aphasia following CVA, the percentage with reading impairments is likely to be substantially higher than this 23.2%. Furthermore, these reading challenges contribute substantially to the decreased quality-of-life experienced by people with aphasia (4). Indeed, people with aphasia report a desire to engage in routine literacy activities that involve accessing and comprehending written materials appearing in a variety of forms (e.g., emails, newspapers, personal mail, books, magazines, websites) (5). Re-establishing the competency of adults with aphasia to process written information is a crucial step in promoting their independence and re-integration into multiple aspects of family and community life.

National Institute of Health (NIH)
National Institute on Deafness and Other Communication Disorders (NIDCD)
Academic Research Enhancement Awards (AREA) (R15)
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Language and Communication Study Section (LCOM)
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Cooper, Judith
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Miami University Oxford
Other Health Professions
Schools of Arts and Sciences
United States
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