How Do Clinicians Judge Fluency in Aphasia?

Gordon, Jean; Clough, Sharice

doi:10.1044/2021_jslhr-21-00484

Cited by 5 publications

(11 citation statements)

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“…One particularly confusing point is that, according to these criteria, even "fluent" aphasias can cause disfluencies at the surface level, for example with the increase of silent pauses due to the speakers struggling while searching for particular words, that will in turn impact perceived fluency (Andreetta & Marini, 2015;Edwards, 2005). These sources of complexity and ambiguity may, at least partially, explain why a poor reliability is often observed in subjective judgements of the fluency of PWA (Clough & Gordon, 2020;Gordon, 1998;Gordon & Clough, 2022;Kerschensteiner et al, 1972;Poeck, 1989). These measures are generally used to categorise/diagnose PWA according to the fluent-nonfluent dichotomy, or as continuous variables that can serve as quantitative indicators for characterizing speech impairments (Clough & Gordon, 2020).…”

Section: Introductionmentioning

confidence: 99%

“…These measures are generally used to categorise/diagnose PWA according to the fluent-nonfluent dichotomy, or as continuous variables that can serve as quantitative indicators for characterizing speech impairments (Clough & Gordon, 2020). From a clinical point of view, the lack of reliability is a highly critical issue since today the majority of speech-language pathologists (SLPs) working with PWA use subjective methods to assess the fluency of their patients (Gordon & Clough, 2022).…”

Section: Introductionmentioning

confidence: 99%

“…As underlined by Clough and Gordon (Clough & Gordon, 2020;Gordon & Clough, 2022), some desirable features of such new fluency metrics would be being continuous rather than categorical, multidimensional rather than bimodal, and objective rather than subjective. The continuity and multimodality of the metrics are meant to overcome the limitations of the too simplistic fluent/nonfluent binary categorization, that has been criticised for long (Poeck, 1989) and leave room for the definition of multidimensional "fluency profiles".…”

Section: Introductionmentioning

confidence: 99%

“…Those profiles would account for the fluency of PWA at different levels of analysis -for example, at one or several of the three levels of increasing linguistic complexity proposed by Clough and Gordon (2020): speech production, lexical retrieval, and grammatical competence. The objective nature of the metrics would guarantee their reliability; however, as some objective methods can be very timeconsuming (e.g., a manual measurement of speech rate), a last desirable feature for the new methods would be being easily practicable in the clinical context (Gordon & Clough, 2022).…”

Section: Introductionmentioning

confidence: 99%

“…More precisely, acquisition studies focus on the assessment of speech fluency at the phonetic, surface level, that is, on the extent to which speech produced by L1/L2 speakers "flows easily without pauses and other disfluency markers" (Derwing & Munro, 2015). Such markers include a number of disfluencies that are also taken into account, along with speech rate and pauses, in the field of aphasiology for characterizing speech fluency: repetitions, repairs and false starts (Faroqi-Shah et al, 2020;Gordon & Clough, 2022;Jacks & Haley, 2015;Wang et al, 2013); they do not, however, include disfluencies occurring at higher linguistic levels, that is, at the lexical and grammatical levels. The studies in L1/L2 acquisition therefore focus on the "speech production" level of speech fluency (Clough & Gordon, 2020) -which is also the scope of the present study.…”

Section: Introductionmentioning

confidence: 99%

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Automatically measuring speech fluency in people with aphasia: first achievements using read-speech data

Fontan¹,

Prince

Nowakowska

et al. 2023

Aphasiology

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Background. Speech and language pathologists (SLPs) often rely on judgements of speech fluency for diagnosing or monitoring patients with aphasia. However, such subjective methods have been criticised for their lack of reliability and their clinical cost in terms of time.Aims. This study aims at assessing the relevance of a signal-processing algorithm, initially developed in the field of language acquisition, for the automatic measurement of speech fluency in people with aphasia (PWA).Methods & Procedures. Twenty-nine PWA and five control participants were recruited via non-profit organizations and SLP networks. All participants were recorded while reading out loud a set of sentences taken from the French version of the Boston Diagnostic Aphasia Examination. Three trained SLPs assessed the fluency of each sentence on a five-point qualitative scale. A forward-backward divergence segmentation and a clustering algorithm were used to compute, for each sentence, four automatic predictors of speech fluency: pseudosyllable rate, speech ratio, rate of silent breaks, and standard deviation of pseudo-syllable length. The four predictors were finally combined into multivariate regression models (a multiple linear regression -MLR, and two non-linear models) to predict the average SLP ratings of speech fluency, using a leave-one-speaker-out validation scheme.Outcomes & Results. All models achieved accurate predictions of speech fluency ratings, with average root-mean-square errors as low as 0.5. The MLR yielded a correlation coefficient of 0.87 with reference ratings at the sentence level, and of 0.93 when aggregating the data for each participant. The inclusion of an additional predictor sensitive to repetitions improved further the predictions with a correlation coefficient of 0.91 at the sentence level, and of 0.96 at the participant level. Conclusions.The algorithms used in this study can constitute a cost-effective and reliable tool for the assessment of the speech fluency of patients with aphasia in read-aloud tasks.Perspectives for the assessment of spontaneous speech are discussed.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Automatically measuring speech fluency in people with aphasia: first achievements using read-speech data

Fontan¹,

Prince

Nowakowska

et al. 2023

Aphasiology

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The Effect of Prosodic Timing Structure on Unison Production in People With Aphasia

Kershenbaum,

Galassi,

Shattuck-Hufnagel

et al. 2023

Am J Speech Lang Pathol

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Purpose: Unison production is a common aphasia treatment technique in which the clinician and the person with aphasia (PWA) produce phrases aloud together. It can be implemented using a typical “conversational,” syntax-influenced prosodic timing structure, or with a “metrical,” beat-based timing structure, but to date no study has directly compared these two approaches. This study compared the effects of metrical versus conversational prosodic timing during unison production on the (a) accuracy of participants' spoken output and (b) timing alignment of participants' productions with the stimuli. Method: PWAs and controls listened to conversationally timed and metrically timed sentences and repeated them in unison with audio recordings. Productions were transcribed and scored in two ways: (a) Accuracy was calculated as the percentage of correctly produced syllables, and (b) timing alignment was determined by extracting the voice onset moment of identical target syllables in the unison stimuli and participant productions in both conditions and comparing the corresponding time points. Results: Metrical timing yielded a greater number of accurate syllables in both groups, with larger effect in PWAs than in controls. Both groups exhibited more anticipatory, less variable timing when speaking along with metrical stimuli, though evidence of such prediction was also present in the conversational condition. Conclusions: Results suggest that unison production works via entrainment—a process that utilizes prediction to guide synchronous production of spoken output. Metrically regular stimuli may facilitate this process as they are more rhythmically predictable. Future work will examine key behavioral variables that predict benefit from unison production and metrical timing.

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Connected Speech Fluency in Poststroke and Progressive Aphasia: A Scoping Review of Quantitative Approaches and Features

Cordella,

Di Filippo,

Kolachalama

et al. 2024

Am J Speech Lang Pathol

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Purpose: Speech fluency has important diagnostic implications for individuals with poststroke aphasia (PSA) as well as primary progressive aphasia (PPA), and quantitative assessment of connected speech has emerged as a widely used approach across both etiologies. The purpose of this review was to provide a clearer picture on the range, nature, and utility of individual quantitative speech/language measures and methods used to assess connected speech fluency in PSA and PPA, and to compare approaches across etiologies. Method: We conducted a scoping review of literature published between 2012 and 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Forty-five studies were included in the review. Literature was charted and summarized by etiology and characteristics of included patient populations and method(s) used for derivation and analysis of speech/language features. For a subset of included articles, we also charted the individual quantitative speech/language features reported and the level of significance of reported results. Results: Results showed that similar methodological approaches have been used to quantify connected speech fluency in both PSA and PPA. Two hundred nine individual speech-language features were analyzed in total, with low levels of convergence across etiology on specific features but greater agreement on the most salient features. The most useful features for differentiating fluent from nonfluent aphasia in both PSA and PPA were features related to overall speech quantity, speech rate, or grammatical competence. Conclusions: Data from this review demonstrate the feasibility and utility of quantitative approaches to index connected speech fluency in PSA and PPA. We identified emergent trends toward automated analysis methods and data-driven approaches, which offer promising avenues for clinical translation of quantitative approaches. There is a further need for improved consensus on which subset of individual features might be most clinically useful for assessment and monitoring of fluency. Supplemental Material: https://doi.org/10.23641/asha.25537237

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How Do Clinicians Judge Fluency in Aphasia?

Cited by 5 publications

References 50 publications

Automatically measuring speech fluency in people with aphasia: first achievements using read-speech data

Automatically measuring speech fluency in people with aphasia: first achievements using read-speech data

The Effect of Prosodic Timing Structure on Unison Production in People With Aphasia

Connected Speech Fluency in Poststroke and Progressive Aphasia: A Scoping Review of Quantitative Approaches and Features

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