Aphasia is an acquired impairment of language abilities resulting from damage to the left hemisphere from stroke, head trauma or other neurological conditions. It can affect any aspect of spoken and/or written language processing and can range from mild to severe. As language provides us with a unique form of communication, aphasia can have profound adverse effects on one's quality of life. Although aphasia is more common in older populations, it can occur at any age, and many people with aphasia want to find ways to return to their premorbid lifestyles, including active careers, to the extent that this is possible. Clearly, there is a need for effective clinical tools to diagnose and treat aphasia, but a third factor makes the possibility of meeting this need a reality: More than 30 years of rehabilitation research provides strong evidence that even in chronic stages of aphasia, behavioral interventions lead to improved language function and changes in neural activity of cortical areas known to support language. This project aims to translate a theory-driven and empirically supported diagnostic battery for aphasia (Temple Assessment of Language and Short-term memory in Aphasia, TALSA) to a clinically feasible test battery that can be used for screening or in-depth measures of a language impairment. Importantly, the TALSA is based on a theoretical model of language that incorporates a role of verbal short-term memory (STM) in language processing. Language and verbal STM impairments commonly co-occur in aphasia, and this model attributes that co-occurrence to a common impairment of processes that support access and retrieval of words: weak activation and/or the inability to maintain activation of linguistic representations during word processing. This level of diagnosis is needed to guide impairment-based treatment approaches that directly stimulate access and retrieval processes. The TALSA is unique in that it includes language tests that add memory load and processing time, variables which are sensitive to these processing impairments. The research version of the TALSA is administered on a computer but is lengthy and not practical in a clinical setting.
Our aim i s to develop a computerized adaptive test version for clinical use. This project will use a Milestone based approach to develop this innovative clinical tool. In the first two years, we will develop the clinical version using focus groups and item response theory to identify the best items and subtests to use in the clinical version of this test (Milestone 1). Goals to meet Milestone 2 will include (1) assessment of participating clinicians' views of current and best practices in aphasia rehabilitation and (2) training participating clinicians on the concepts behind the TALSA, as well as specifics about its administration and interpretation. Milestone 3 will involve implementation of the clinical version in the clinical settings and assessment of clinicians' responses to its usefulness and validation of the clinical version, in relation to the original version. Plans for dissemination of the final clinical version of the TALSA will include development of a secured website enabling access to the preliminary version (in Years 3-5) and arrangements for publication of the final version in Year 5.
Approximately one million people in the United States have aphasia, a language impairment most often resulting from a stroke (National Aphasia Association). Research indicates that verbal short-term memory (STM) impairment commonly co-occurs with language impairment in aphasia, and recent approaches to treatment address both abilities. We have developed a comprehensive test battery that is unique in its coverage of language and verbal STM abilities and this project aims to develop a clinical version of this test.
| Martin, Nadine; Minkina, Irene; Kohen, Francine P et al. (2018) Assessment of linguistic and verbal short-term memory components of language abilities in aphasia. J Neurolinguistics 48:199-225 |
