Stakeholder-Engaged Research: Examples From Aphasia

doi:10.1097/tld.0000000000000307

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“…While listener perceptions of communication are not free from risk of bias, it may be possible to mediate these risks through more diverse involvement of raters and participants, specific training in the use of the tools, and by improving graduate education programs in speech pathology to ensure the development of culturally competent clinicians. Despite a recent push to integrate lived experiences into aphasia assessments and treatments (Hinckley, 2023), this scoping review did not identify that any transcription-less scales were developed in concert with partners (i.e., clients with aphasia, practising speech language pathologists). It is well known that co-design elicits ideas and fosters an environment in which concepts, knowledge, and lived experiences are applied to develop tools that meet individuals' needs, which are then more valid, have higher utility, take into account sociocultural considerations, and are more likely to be adopted for use (Page et al, 2016;Sanders & Stappers, 2008;Wilson et al, 2015).…”

Section: Future Directions For Transcription-less Tool Creation and V...mentioning

confidence: 99%

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

Stark¹,

Dalton²

2023

Preprint

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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.

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Section: Future Directions For Transcription-less Tool Creation and V...mentioning

confidence: 99%

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

Stark¹,

Dalton²

2023

Preprint

View full text Add to dashboard Cite

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

Stark,

Dalton

2024

Intl J Lang & Comm Disor

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BackgroundIt is important to capture a comprehensive language profile from speakers with aphasia. One way to do this is to evaluate spoken discourse, which is language beyond a single simple clause used for a specific purpose. While the historical trend in aphasiology has been to capture performance during isolated language tasks, such as confrontation naming, there is a demonstrated need and benefit to collecting language information from tasks that resemble everyday communication. As a result, there has been an increase in discourse analysis research over time. However, despite clinicians’ and researchers’ desire to analyse spoken discourse, they are faced with critical barriers that inhibit implementation.AimsTo use scoping review methodology to identify transcription‐less tools developed to analyse discourse from individuals with aphasia. The review addressed the following question: ‘What transcription‐less tools and analysis procedures are available to assess discourse in people with aphasia?’ and included several sub‐questions to further characterise the type of discourse and tool being used, participants on whom the tool was used to rate discourse abilities, tool users (raters), and psychometric properties.MethodsThe scoping review was conducted between the months of October 2022 and January 2023, concluding 30 January 2023, on PubMed/NCBI, Academic Search Complete and Linguistics and Language Behavior Abstracts. Major inclusion parameters included peer‐reviewed papers written in English; that the tool was used to analyse discourse elicited by individuals with acquired aphasia; and that the tool was not a part of a standardised battery or assessment. Perceptual discourse analysis was defined as any analysis which primarily relied on listener impressions and did not numerically quantify specific language behaviours. ‘Transcription‐less’ analysis was defined as any discourse analysis which did not require a written record of the discourse sample in order to be completed. A total of 396 abstracts were screened and 39 full articles were reviewed, yielding 21 papers that were included in the review.Main ContributionAn overview of the state of transcription‐less tools for aphasic discourse analysis is provided, and next steps are identified to facilitate increased implementation of discourse analysis in clinical and research settings.ConclusionTranscription‐less tools have many benefits for analysing multiple levels (e.g., linguistic, propositional, macrostructural, pragmatic) of discourse, but require more research to establish sound psychometric properties and to explore the implementation of these tools in clinical settings.What this paper addsWhat is already known on this subject Individuals with aphasia prioritise treatment outcomes at the discourse level such as being able to engage in conversations with friends and family about important topics and participating in social and leisure activities. However, discourse is rarely used as a treatment outcome measure in clinical practice due to multiple barriers. When speech‐language pathologists do assess discourse, they often make perceptual judgements without transcribing the discourse sample. Transcription‐less analysis procedures may improve clinical implementation of discourse assessment, which would better match treatment outcome measurement to clients’ desired outcomes. However, little is known about the current state of transcription‐less discourse analysis, blocking progress.What this paper adds to existing knowledge This study provides an overview of currently available transcription‐less discourse analysis procedures that are not part of published standardised aphasia assessments. Transcription‐less measures are available to evaluate discourse at all levels (i.e., lexical, propositional, macro‐structural/planning, and pragmatic) and most measures include items that assess discourse abilities across multiple levels. Additionally, there are transcription‐less measures available for both structured (e.g., picture scene description) and spontaneous (e.g., conversation) discourse tasks. However, current transcription‐less procedures are lacking psychometric data including information about validity and reliability.What are the potential or actual clinical implications of this work? Transcription‐less analysis methods may provide an avenue for increased implementation of discourse measurement into clinical practice. Further research is needed to determine the clinical utility of transcription‐less discourse analysis to better monitor clients’ desired treatment outcomes.

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Stakeholder-Engaged Research: Examples From Aphasia

Abstract: The other research . . . it's like guinea pigs . . . they tell you what is about and really you can't change it.

Cited by 2 publications

References 7 publications

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

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

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

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