A scoping review of transcription-less practices for analysis of aphasic discourse and implications for future research

Abstract

Evaluating spoken discourse in aphasia has gained considerable traction over the last thirty years (Bryant et al., 2016). The field has defined spoken discourse in a variety of ways. We use the description of spoken discourse provided by Armstrong (2000): language beyond a single simple clause used for a specific purpose. There are several reasons that aphasic discourse assessment and analysis has received considerable focus in the past three decades: Individuals with aphasia cite improving their ability to converse – a type of discourse – as a top priority (Worrall et al., 2011); Researchers and clinicians agree that assessing and analyzing discourse enables comprehensive characterization of language and its use (Dipper et al., 2021; Stark et al., 2021);Analyzing discourse may provide the most sensitive and accurate portrayal of language ability in individuals with mildest aphasia (Fromm et al., 2017);Because of the variety of elicitation methods that exist for discourse (e.g., narrative [fictional, personal], picture description or exposition), evaluating discourse also enables evaluating the interaction of language with other cognitive processes, such as executive function and long-term memory, and how language changes when the topic becomes more salient (or “tellable”) for the individual (H. Ulatowska & Bond Chapman, 1989; H. K. Ulatowska et al., 1983; H. K. Ulatowska & Olness, 2004);Characterizing discourse in acquired and progressive neurological disorders can improve specificity and modification of treatment and goal-setting, e.g., how some treatments generalize to discourse and the mechanisms of generalization (Boyle, 2011, 2020);Discourse, compared with language tested in isolation (e.g., naming), may provide a means of understanding how language is influenced by culture and other important variables, such as ethnicity and geographic location (Olness et al., 2002; H. K. Ulatowska et al., 2003); Enables evaluation of multimodal communication components, such as manual gesture, which is known to be more prevalent in people with aphasia and used to supplement (add, disambiguate, replace) speech (de Beer et al., 2019, 2020; Lanyon & Rose, 2009; Sekine & Rose, 2013; van Nispen et al., 2017);While assessing and analyzing discourse carry a large number of benefits (again highlighted by a variety of recent survey studies: Bryant et al., 2017; Cruice et al., 2020; Stark et al., 2021), there are considerable barriers in both research and clinical settings (Bryant et al., 2017, 2019; Cruice et al., 2020; Dietz & Boyle, 2018b, 2018a; Stark et al., 2021; Wright, 2011). These barriers include:Outdated assessments, which at best have lead to decrease tellability (a tellable event/elicitation method/set of instructions likely enhances many aspects of the discourse, like global coherence (Olness & Ulatowska, 2011) and at worst, perpetuate longstanding stereotypes and biases (Berube et al., 2019);Limited time, because of the timeliness it takes to transcribe speech (some estimate 10-15 minutes to transcribe per 1 minute of aphasic speech; CITE), analyze, and interpret data (Stark et al., 2021);Limited tools, which interacts with limited training and professional development, in that clinicians and researchers both note that tools to analyze aphasic discourse can be difficult to acquire / learn / use (Stark et al., 2021) and that existing tools may be limited in their psychometric properties, such as limited evidence regarding validity, reliability, and feasibility (CITE);Here, we provide a narrative review of the current state of transcription-less analysis (sometimes called “judgment-based” analysis, perceptual analysis, subjective analysis, “without transcription” analysis), which is a highly desired tool because it has the potential to address the barriers of time and tool availability.