There is currently insufficient information available to justify the use of discourse information measures as sole diagnostic or outcome measurement tools. Yet the majority of measures are rooted in relevant theory, and there is emerging evidence regarding their psychometric properties. There is significant scope for further psychometric strengthening of discourse information measurement tools.

BackgroundPrevious research has found that people with aphasia produce more spontaneous iconic gesture than control participants, especially during word-finding difficulties. There is some evidence that impaired semantic knowledge impacts on the diversity of gestural handshapes, as well as the frequency of gesture production. However, no previous research has explored how impaired semantic knowledge impacts on the frequency and type of iconic gestures produced during fluent speech compared with those produced during word-finding difficulties.AimsTo explore the impact of impaired semantic knowledge on the frequency and type of iconic gestures produced during fluent speech and those produced during word-finding difficulties.Methods & ProceduresA group of 29 participants with aphasia and 29 control participants were video recorded describing a cartoon they had just watched. All iconic gestures were tagged and coded as either “manner,” “path only,” “shape outline” or “other”. These gestures were then separated into either those occurring during fluent speech or those occurring during a word-finding difficulty. The relationships between semantic knowledge and gesture frequency and form were then investigated in the two different conditions.Outcomes & ResultsAs expected, the participants with aphasia produced a higher frequency of iconic gestures than the control participants, but when the iconic gestures produced during word-finding difficulties were removed from the analysis, the frequency of iconic gesture was not significantly different between the groups. While there was not a significant relationship between the frequency of iconic gestures produced during fluent speech and semantic knowledge, there was a significant positive correlation between semantic knowledge and the proportion of word-finding difficulties that contained gesture. There was also a significant positive correlation between the speakers' semantic knowledge and the proportion of gestures that were produced during fluent speech that were classified as “manner”. Finally while not significant, there was a positive trend between semantic knowledge of objects and the production of “shape outline” gestures during word-finding difficulties for objects.ConclusionsThe results indicate that impaired semantic knowledge in aphasia impacts on both the iconic gestures produced during fluent speech and those produced during word-finding difficulties but in different ways. These results shed new light on the relationship between impaired language and iconic co-speech gesture production and also suggest that analysis of iconic gesture may be a useful addition to clinical assessment.

This is the unspecified version of the paper.This version of the publication may differ from the final published version. Permanent City Research OnlinePre-publication copy. Published in INT J LANG COMMUN DISORD, JULY-AUGUST 2011, VOL. 46, NO. 4, 423-436 What can iconic gestures tell us about the language system? A case of conduction aphasia.Authors: Naomi Cocks, Lucy Dipper, Ruth Middleton and Gary Morgan AbstractBackground: Speech and language therapists rarely analyse iconic gesture when

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Background: Discourse assessment and treatment in aphasia rehabilitation is a priority focus for a range of stakeholder groups. However, a significant majority of speech and language therapists (SLTs) infrequently conduct discourse analysis, and do not feel competent in doing so. Known barriers identified in other countries, specifically a lack of time, training, expertise and resources, affect use of discourse analysis in clinical practice. Aims: To investigate UK SLTs' reported practices and views of discourse analysis, barriers and facilitators, and clinical feasibility in aphasia rehabilitation. Methods & Procedures:An online survey of 52 questions adapted from existing research and incorporating behaviour change literature was created for the study and piloted. UK SLTs working in aphasia rehabilitation for at least 6 months were invited to participate. Potential participants were contacted through national and local clinical excellence networks, a National Health Service (NHS) bespoke e-mail list, and national magazine advertisement, and the study was also advertised on social media (Twitter). Therapists read an online participant information sheet and submitted individual electronic consent online; then progressed to the Qualtrics survey. Descriptive, correlational and inferential statistical analyses were conducted, and content analysis was carried out on the questions requiring text. Outcomes & Results: A total of 211 valid responses were received from primarily female SLTs, aged 20-40 years, working full-time in the NHS in England, in community, inpatient and acute/subacute multidisciplinary settings. A total of 30% SLTs collected discourse analysis often, were mostly very experienced, and working part-time in community settings. Years of experience was predictive of use. Discourse was most often collected using standardized picture descriptions and recounts during initial assessment. Samples were infrequently recorded, and typically transcribed in real-time. Most SLTs (53-95%) reported making clinical judgements or manually counted words, sentences, communication of ideas and errors, and were confident in doing so. Barriers included time constraints; lack of expertise, confidence, training, resources and equipment; and patient severity. Discourse 'super-users' were distinguished by significantly higher professional motivation for discourse and workplace opportunity than other SLTs, and 'non-users' were distinguished by significantly less knowledge and skills in discourse analysis than other SLTs. SLTs reported a desire and need for training, new/assistive tools and time to do more discourse analysis in practice.Conclusions & Implications: Clinicians were highly engaged and relatively active in at least some aspects of discourse analysis practice. Interventions that target individual clinicians as well as organizations and systems are needed to improve the uptake of discourse analysis in practice. 418Madeline Cruice et al. What this paper addsWhat is already known on the subject? r Discourse in aphasia r...

This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link:http://openaccess.city.ac.uk/3571/ Link to published version: http://dx.doi.org/10.1111/j. 1471-3802.2010.01184.x Copyright and reuse: City Research Online aims to make research outputs of City, University of London available to a wider audience. Copyright and Moral Rights remain with the author(s) and/or copyright holders. URLs from City Research Online may be freely distributed and linked to. City Research Online: http://openaccess.city.ac.uk/ publications@city.ac.uk City Research OnlineImplementing AAC with children with profound and multiple learning disabilities: A study in rationale underpinning intervention. Implementing AAC with children with profound and multiple learning disabilities: A study in rationale underpinning intervention.2 Abstract:There is a developing research base to support the rationale underpinning words. Key words: profound and multiple learning disabilities; functional communication; augmentative supports; communication opportunities.Implementing AAC with children with profound and multiple learning disabilities: A study in rationale underpinning intervention. 3 1.Introduction.This paper seeks to explore the processes involved in planning the development of augmentative and alternative (AAC) systems for two children who are described as having profound and multiple disabilities (PMLD). Aside from the processes involved, it will consider the evidence base underpinning the selection of AAC materials, and it will attempt to consider the strategies that are necessary when developing appropriate supports for these children.AAC is described as an area of clinical practice that attempts to compensate (temporarily or permanently) for the impairment and disability patterns of individuals with severe disorders of communication. (Beukelman & Mirenda, 1992 Light, Collier & Parnes, 1985). However, the evidence and methodology underpinning the process of implementing AAC support for people with profound and multiple disabilities is unclear.The term "profound and multiple disabilities" or PMLD is used to describe individuals who have a profound cognitive impairment alongside multiple disabilities including physical, sensory and /or health related difficulties, (WHO, 1992;Cartwright & Wind-Cowie, 2005). Consequently, those with PMLD are likely to be pre-verbal communicators and may require carers and significant others to interpret their non-verbal communication signals as well as using touch, natural gesture and objects with them to support their language and communication opportunities within the environment, (Guess et al., 1993;Green et al., 1996;Bloom, 1993;Brooks, 2005;Franco, 1997;Locke, 1997).Implementing AAC with children with profound and multiple learning disabilities: A study in rationale underpinning intervention. 4Difficulties with communication place children who have PMLD at risk of becoming excluded and may often lead to "social and edu...

The current study is the first to psychometrically profile measures of discourse in aphasia. It contributes to the field by identifying Story Grammar, Topic Coherence, Reference Chains and PAS as the most psychometrically robust discourse measures yet profiled with speakers with aphasia. Until further data are available indicating the strength of other discourse measures, caution should be applied when using them.

This is the unspecified version of the paper.This version of the publication may differ from the final published version. Permanent repository link AbstractSome people with aphasia may have trouble with verbs because of fundamental difficulties in processing situations in a way that maps readily onto language. The present paper describes a novel assessment, the Order of Naming Test, that offers an insight into the conceptual processing of events through the order in which people name the entities involved. The performance of non-brain damaged control participants is described. The responses of two people with non-fluent aphasia are then discussed. Both 'Helen' and 'Ron' showed significant difficulty with verbs and sentences. Ron in addition had trouble on a range of tasks that tapped aspects of event processing, despite intact non-verbal cognition. While Helen's performance on the Order of Naming Test was very similar to the controls, Ron's differed in a number of respects, suggesting that he was less focused on the main entities involved in the events. However, certain aspects of his response pointed at covert event processing abilities that might be fruitfully exploited in therapy.3