Background: The greatest degree of language recovery in post-stroke aphasia takes place within the first weeks. Aphasia severity and lesion measures have been shown to be good predictors of long-term outcomes. However, little is known about their implications in early spontaneous recovery. The present study sought to determine which factors better predict early language outcomes in individuals with post-stroke aphasia. Methods: Twenty individuals with post-stroke aphasia were assessed <72 h (acute) and 10-14 days (subacute) after stroke onset. We developed a composite score (CS) consisting of several linguistic sub-tests: repetition, oral comprehension and naming. Lesion volume, lesion load and diffusion measures [fractional anisotropy (FA) and axial diffusivity (AD)] from both arcuate fasciculi (AF) were also extracted using MRI scans performed at the same time points. A series of regression analyses were performed to predict the CS at the second assessment. Results: Among the diffusion measures, only FA from right AF was found to be a significant predictor of early subacute aphasia outcome. However, when combined in two hierarchical models with FA, age and either lesion load or lesion size, the initial aphasia severity was found to account for most of the variance (R 2 = 0.678), similarly to the complete models (R 2 = 0.703 and R 2 = 0.73, respectively). Conclusions: Initial aphasia severity was the best predictor of early post-stroke aphasia outcome, whereas lesion measures, though highly correlated, show less influence on the prediction model. We suggest that factors predicting early recovery may differ from those involved in long-term recovery.

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Background: Discourse analysis allows the examination of functional and ecological language impairment in post-stroke aphasia. Given its complexity, various methods of analysis have been developed to measure the multiple components of discourse. Clinical assessment usually includes discourse analysis, but how clinicians should assess recovery of discourse, particularly in acute care settings, is still a matter of debate. Aims: This study aimed to measure improvements in discourse production in early post-stroke aphasia recovery. Methods & Procedure: Twenty-three persons with aphasia following a first left middle cerebral artery stroke were recruited in the stroke unit of Hôpital du Sacré-Coeur de Montréal (May 2015-July 2018). Patients treated with thrombolysis (n=10) and untreated patients underwent two aphasia assessments (0 to 72 hours, 7 to 14 days post-onset). Discourse assessment consisted of the picture description task from the Western Aphasia Battery (Kertesz, 2006). Changes in microlinguistic and thematic informativeness measures between the two assessment periods were analyzed. Outcomes & Results: In-depth microlinguistic analyses showed no significant difference between the initial and follow-up assessments. Conversely, some thematic informativeness variables improved significantly during the same time period. Patients treated with thrombolysis produced more thematic units than untreated patients at both assessments, but the change between the two groups was not significant. Conclusions & Implications: This study suggests that thematic informativeness variables are sensitive to language improvement in early post-stroke aphasia recovery whereas no microlinguistic variables improved significantly in the same period. In contrast to previous evidence, the difference between patients treated with thrombolysis and untreated patients was not evident over time. The results suggest that thematic informativeness constitutes an interesting path to explore as NARRATIVE DISCOURSE RECOVERY Aphasiology (accepted) 4 a routine clinical assessment in acute-care settings because it is time-efficient, simple to conduct and reliable in assessing early changes in the discourse production of individuals with aphasia in the acute post-stroke phase.

Background A growing body of literature has demonstrated the importance of discourse assessment in patients who suffered from brain injury, both in the left and right hemispheres, as discourse represents a key component of functional communication. However, little is known about the relationship between gray matter density and macrolinguistic processing. Purpose This study aimed to investigate this relationship in a group of participants with middle–low to low socioeconomic status. Method Twenty adults with unilateral left hemisphere ( n = 10) or right hemisphere ( n = 10) chronic ischemic stroke and 10 matched (age, education, and socioeconomic status) healthy controls produced three oral narratives based on sequential scenes. Voxel-based morphometry analysis was conducted using structural magnetic resonance imaging. Results Compared to healthy controls, the left hemisphere group showed cohesion impairments, whereas the right hemisphere group showed impairments in coherence and in producing macropropositions. Cohesion positively correlated with gray matter density in the right primary sensory area (PSA)/precentral gyrus and the pars opercularis. Coherence, narrativity, and index of lexical informativeness were positively associated with the left PSA/insula and the superior temporal gyrus. Macropropositions were mostly related to the left PSA/insula and superior temporal gyrus, left cingulate, and right primary motor area/insula. Discussion Overall, the present results suggest that both hemispheres are implicated in macrolinguistic processes in narrative discourse. Further studies including larger samples and with various socioeconomic status should be conducted. Supplemental Material https://doi.org/10.23641/asha.14347550

Background: Previous findings have demonstrated the importance of discourse analysis in post-stroke aphasia, as it allows for in-depth examination of language impairment and represents key components of functional communication.However, little is known about the recovery of discourse over time. Aims:The main aim of this study is to measure the longitudinal changes in descriptive discourse production from the acute to chronic stages of post-stroke aphasia recovery. The secondary aim is to explore the association between discourse measures and overall language impairment severity measures at different testing points.Methods & Procedure: Seventeen French Canadian speakers with various types and severities of aphasia following a first left middle cerebral artery stroke participated in this study. They underwent three language assessments (acute: 0 to 72 hours; subacute: 7 to 14 days; chronic: 6 to 12 months post-onset). The picture description from the Western Aphasia Battery was analyzed at three time points.Changes in terms of thematic informativeness and microstructural variables were analyzed.Outcomes & Results: Regarding the micro-structural variables, the mean length of utterances (MLU) and the number of words per minute showed significant positive changes between the acute and chronic phases. For the thematic informativeness measures, the number of thematic units (TUs), the number of thematic units per minute (TUs/min) and the number of thematic units per utterance (TUs/utt)

Objective: Individuals with a stroke in either the left hemisphere (LH) or the right hemisphere (RH) often present macrostructural impairments in narrative abilities. Understanding the potential influence of low education and low socioeconomic status (SES) is critical to a more effective assessment of poststroke language. The first aim was to investigate macrostructural processing in low-education and low-SES individuals with stroke in the LH or RH or without brain damage. The second aim was to verify the relationships between macrolinguistic, neuropsychological, and sociodemographic variables. Method: Forty-seven adults with LH ( n = 15) or RH ( n = 16) chronic ischemic stroke and 16 matched (age, education, and SES) healthy controls produced three oral picture-sequence narratives. The macrostructural aspects analyzed were cohesion, coherence, narrativity, macropropositions, and index of lexical informativeness and were compared among the three groups. Then, exploratory correlations were performed to assess associations between sociodemographic (such as SES), neuropsychological, and macrostructural variables. Results: Both the LH and the RH presented impairments in the local macrostructural aspect (cohesion), whereas the RH also presented impairments in more global aspects (global coherence and macropropositions). All five macrostructural variables correlated with each other, with higher correlations with narrativity. Naming was correlated with all macrostructural variables, as well as prestroke reading and writing habits (RWH), showing that higher naming accuracy and higher RWH are associated with better macrostructural skills. Conclusions: The present results corroborate the role of the LH in more local processing and that of the RH in more global aspects of discourse. Moreover, this study highlights the importance of investigating discourse processing in healthy and clinical populations of understudied languages such as Brazilian Portuguese, with various levels of education, SES, and RWH.

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Purpose The main aim of this study is to provide French Canadian reference data for quantitative measures extracted from connected speech samples elicited by the Western Aphasia Battery–Revised picnic scene, a discourse task frequently used in clinical assessment of acquired language disorders. Method Our sample consisted of 62 healthy French Canadian adults divided in two age groups: a 50- to 69-year-old group and a 70- to 90-year-old group. Results High interrater reliability scores were obtained for most of the variables. Most connected speech variables did not demonstrate an age effect. However, the 70- to 90-year-old group produced more repetitions than the 50- to 69-year-old group and displayed reduced communication efficiency (number of information content units per minute). Conclusion These findings contribute to building a reference data set to analyze descriptive discourse production in clinical settings.