The effect of semantic feature analysis (SFA) treatment on confrontation naming and discourse production was examined in 2 persons, 1 with anomic aphasia and 1 with Wernicke's aphasia. Results indicated that confrontation naming of treated nouns improved and generalized to untreated nouns for both participants, who appeared to have different lexical access impairments. Both participants demonstrated improvement in some aspects of discourse production associated with the confrontation naming SFA treatment. However, there was no change in most manifestations of lexical retrieval difficulty during discourse for either participant. These findings support previous work regarding improved and generalized naming associated with SFA treatment and indicate a need to examine effects of improved confrontation naming on more natural speaking situations.

Purpose: This study examined the test–retest stability of select word-retrieval measures in the discourses of people with aphasia who completed a 5-stimulus discourse task. Method: Discourse samples across 3 sessions from 12 individuals with aphasia were analyzed for the stability of measures of informativeness, efficiency, main concepts, noun and verb retrieval, word-finding difficulty, and lexical diversity. Values for correlation coefficients and the minimal detectable change score were used to assess stability for research and clinical decision making. Results: Measures stable enough to use in group research studies included the number of words; the number of correct information units (CIUs); the number of accurate-complete, accurate-incomplete, and absent main concepts; the percentage of T-units that had word-finding behaviors of any kind; the percentage of T-units that contained empty words; and a lexical diversity measure. Words per minute, CIUs per minute, and the percentage of T-units that contained time fillers or delays were sufficiently stable to use when making clinical decisions about an individual. Conclusion: Although several of the measures demonstrated acceptable stability for group research studies, relatively few were sufficiently stable for making clinical decisions about individuals on the basis of a single administration.

Discourse (a unit of language longer than a single sentence) is fundamental to everyday communication. People with aphasia (a language impairment occurring most frequently after stroke, or other brain damage) have communication difficulties which lead to less complete, less coherent, and less complex discourse. Although there are multiple reviews of discourse assessment and an emerging evidence base for discourse intervention, there is no unified theoretical framework to underpin this research. Instead, disparate theories are recruited to explain different aspects of discourse impairment, or symptoms are reported without a hypothesis about the cause. What is needed is a theoretical framework that would clarify the specific linguistic skills that create completeness, coherence, and complexity (i.e., richness) in discourse, and illuminate both the processes involved in discourse production and the reasons for breakdown. This paper reports a review and synthesis of the theoretical literature relevant to spoken discourse in aphasia discourse, and we propose a novel theoretical framework which unites these disparate sources. This framework is currently being tested as the foundation for Linguistic Underpinnings of Narrative in Aphasia (LUNA) treatment research. In this paper, we outline the novel framework and exemplify how it might be used to guide clinical practice and research. Future collaborative research is needed to develop this framework into a processing model for spoken discourse.

Background: Impairment-focused aphasia treatment has an ultimate goal of improving language production in connected speech and communication in daily life. Although impairment-based treatment has typically been carried out in words or sentences, investigations have begun to explore the efficacy of treatment during discourse production. Focusing treatment on an impaired linguistic process during discourse production is a complex and challenging endeavour. Aims: This paper aims to review investigations of discourse treatment for word retrieval impairment in aphasia in order to identify and discuss variables that emerge as being important considerations in clinical practice and continued research. Main Contribution: Seven investigations that applied treatments during structured discourse production to improve word retrieval in participants with aphasia were reviewed. Treatment methods used in the investigations included phonologic and orthographic cues, semantic feature analysis, contingency-based cueing hierarchies, and repeated conversational engagement. The discourse contexts used for treatment were structured conversations or structured narrative discourse. All investigations reported positive outcomes for improved word retrieval abilities. Although treated vocabulary items did not improve in all cases, improvements in general processes of word retrieval were reported. Focusing treatment on the linguistic process of word retrieval resulted in changes to discourse macrostructure, at least in terms of the informativeness of the discourse. When attitudes and perceptions of the participants with aphasia or of naïve judges were assessed, the outcomes were generally favourable. One investigation provided evidence that treatment in structured discourse was related to improved word retrieval in real-life conversations. Conclusions: There are several promising discourse treatment approaches for word retrieval impairments in aphasia. Systematic analysis of changes in the macrolinguistic processes of discourse, in real-life conversations, and in the attitudes and perceptions of participants with aphasia and others in future discourse treatment studies would enhance our insights about their efficacy.

Improved discourse production is a priority for all key stakeholders in aphasia rehabilitation. A Cochrane review of randomised controlled trials (RCTs) for aphasia found speech and language therap...

Although spoken discourse is an outcome prioritised by all stakeholders in aphasia rehabilitation, assessment and treatment of discourse are not routine clinical practice. The small evidence base, ...