Research within aphasiology, speech-language pathology (SLP), and other rehabilitation fields often excludes people with severe aphasia (Brady et al., 2013; Hilari & Byng, 2009). Additional challenges arise from a lack of clarity in defining “severe aphasia,” as well as a lack of consensus regarding the best protocols to assess language and cognitive functions in this population. Consequently, the empirical literature examining the evaluation and treatment of people with severe aphasia lags behind reports of individuals with mild to moderate aphasia. Therefore, many aphasia research findings and clinical recommendations may not apply to those with severe aphasia (e.g., Edmonds & Babb, 2011; Salis et al., 2021). Improved inclusion of people with severe aphasia may require a better understanding of how it is defined and assessed in the current literature. Accordingly, we present results of a state-of-the-art scoping review of the literature addressing the following questions: (1) How is “severe aphasia” defined in the extant literature? (2) What are the current practices for evaluating and quantifying language, cognition, functional communication, and quality of life in people with severe aphasia? 2a. What tools have been used to identify strengths, weaknesses, and strategies for communication? 2b. How do the assessment tools used in contemporary extant literature represent the levels of the World Health Organization International Classification of Functioning, Disability and Health (WHO, 2018) and/or Living with Aphasia: Framework for Outcome Measurement (Kagan et al., 2008)? 2c. What are the psychometric strengths of current assessment tools for severe aphasia? 2d. How have these assessment tools been used to capture change? METHODS: Seven electronic databases were searched for articles published from January 1, 2010, to December 15, 2023. Results were documented using the PRISMA for Scoping Reviews guidelines (Tricco et al., 2018). We included studies that specifically reported participants with severe aphasia; described, defined and/or quantified in any way; using any formal or informal assessment tool(s) in any setting (e.g., medical, rehabilitation). RESULTS AND DISCUSSION: Following duplicate removal, 7,040 studies were title/abstract screened, 1,675 full text screened, and a total of 597 papers included for data extraction. Initial results demonstrate that the definition, description, and assessment of severe aphasia is often not clearly stipulated and varies widely within the aphasia and broader medical literature, particularly across different disciplines (e.g., medicine, psychology, SLP). Delineation of current definitions and practices for evaluating and quantifying language, cognition, functional communication strengths, and quality of life in severe aphasia will be discussed along with a review of clinical implications.

Learning is central to success in rehabilitation following brain injury, but how the damaged brain learns, or relearns, is not well-understood. Most learning in rehabilitation relies on explicit instruction. However, implicit-statistical learning (ISL) is the type of learning that occurs during the acquisition of higher-cognitive skills, like language. ISL is a type of learning that occurs outside immediate awareness and is a prerequisite for language acquisition. Thus, it may be expected that ISL is also relevant to language relearning as it occurs in rehabilitative efforts. To investigate the status of ISL post brain injury, auditory and visual non-native or artificial grammar tasks were administered to nine individuals with post-stroke aphasia (PSA) and ten age- and gender-matched healthy adults. Language and severity of aphasia was characterized in the PSA participants. ISL and cognitive assessments were completed for all participants. The ISL tasks employed aXb grammars where the statistical relationship between a and b relied on X. Training phases included Norwegian sentences for the auditory task and symbol strings for the visual task. Evidence of ISL was defined as above chance accuracy calculated with d’ in a forced choice paradigm in a test phase. Aphasia severity for the PSA participants ranged from moderately severe to very mild (Western Aphasia Battery-Revised Aphasia Quotient [AQ] 34.7 – 99.1) with classifications of 4 Latent, 2 Anomic, 1 Broca, 1 Transcortical Motor, and 1 Conduction. The PSA individuals performed similarly to the healthy controls for nonverbal intelligence, sustaining focused attention, and episodic memory, but poorer for cognitive flexibility/switching (t(14) = -3.375, p = 0.002) and verbal short term memory (t(17) = -2.751, p = 0.007). Six of the PSA and 8 of the controls performed above chance on the auditory ISL and 7 PSA and 10 controls were above chance for the visual ISL task. There was no significant group difference for input modality (auditory: U = 44.5, p = 0.97; visual: U = 34.5, p = 0.63). Auditory ISL correlated moderately with verbal short-term memory for delayed (5-second) nonword repetition (rho(19) = 0.47, p = 0.04), but no significant correlations existed with visual ISL. Aphasia severity was not correlated with ISL. Of the 4 participants with PSA performing below chance, one did so on both ISL tasks (latent aphasia, age 83, AQ = 94.2), two on the auditory ISL (anomic, age 64, AQ = 85.4; Broca, age 63, AQ = 34.7), and one on the visual ISL task (anomic, age 69, AQ = 90.7). These preliminary data suggest that individuals with PSA learn through ISL means in both auditory and visual modalities but have more difficulty with auditory ISL when verbal short-term memory is limited, as was also the case in the healthy comparison group.

Background: Social communication disorders are common after traumatic brain injury (TBI) and significantly affect workplace interaction and job retention. Linguistic politeness norms govern workplace discourse. However, omission of normative linguistic politeness markers, or potentially worse, instances of linguistic (im)politeness, are detrimental to the social standing and employability of individuals with TBI. We will present how we applied sociolinguistics to analyze social communication using measures of politeness and (im)politeness strategies in recorded language elicitations. We will outline how we elicited, collected, coded, and analyzed linguistic politeness and impoliteness using the Voicemail Elicitation Task (VET) and the Feedback/Advice Spoken Task (FAST). The VET and FAST are computer-based language elicitation tasks related to workplace communication. The VET elicits the speech acts of informing and requesting, while the FAST elicits the speech act of feedback and advice, which are more complex to execute. We expected increased instances of impoliteness and decreased politeness in the FAST compared to the VET.

Methods: In a comparative observational study of participants with TBI (n=37, 22-65 years of age with moderate to severe TBI) and healthy controls (n=25), we analyzed VET and FAST for both politeness and (im)politeness. English was the primary language in all subjects. We compared the performance between groups.

Results: Eleven participants with TBI demonstrated 27 tokens of impoliteness across 11 different types/codes (e.g., pointed criticism, threats, dismissals). Eight control participants demonstrated only six tokens of impoliteness across four different types/codes. Fewer instances of impoliteness recorded resulted in a non-normal data distribution, necessitating a non-parametric analysis for preliminary results. Comparisons of Impoliteness tokens in persons with TBI versus controls approached significance. VET measure: U = 528.5, p = 0.138; FAST measure: U = 62.5, p = 0.397. There was a significant difference in the frequency of politeness markers used; VET analysis: Politeness Markers per Minute (PMpM) F(1,62) = 21.064, p < 0.001; FAST measure of PMpM F(1,20) = 5.111, p <0.05.

Discussion: Preliminary findings indicate that persons with TBI present with more impoliteness tokens. Additionally, persons with TBI presented a larger variety of impoliteness types/codes.

Next Steps: We will continue to recruit participants and present updated findings. Additionally, we will present data for inter-rater coding reliability. A parameter of ongoing interest to researchers is social validity ratings from naïve listeners, with data collection still in progress. We anticipate that social validity results will indicate a greater subjective impression of offense for impoliteness instances spoken by persons with TBI than control recordings. For instance, persons with TBI utilized threats, coercion, condescension, dismissals, and sarcasm, whereas controls utilized none of these personalized impoliteness types. Specific examples from recordings will be presented with consideration of the workplace context when interpreting the results.

Background: Cognitive communication disorder commonly occurs after traumatic brain injury (TBI) and may be most evident in spoken discourse. Management of discourse is a critical component of speech-language pathology (SLP) practice, and SLPs elicit narrative samples as part of clinical practice post-TBI (Hoffman et al., 2024; Steel et al., 2024. Research literature has reported extensively on use of narrative discourse to characterize changes post-TBI, using a range of visual elicitation stimuli. However, the form of visual stimuli can influence the person’s cognitive and emotional response and engagement. The purpose of this study was to identify and review visual stimulus materials used in narrative discourse tasks for cognitive communication disorders after TBI. A scoping review was used to collate the visual materials used in empirical research for spoken narrative elicitation post-TBI. We aimed to examine the format, structure, and sources of visuals used. Discourse analyses were also investigated.

Methods: The review followed PRISMA extension guidelines for scoping reviews. Searches were conducted between 26th September 2023 and 1st March 2024, in four electronic databases. We sought peer-reviewed original research studies reporting spoken narrative tasks using visual elicitation stimuli after TBI. Secondary searches were also undertaken.

Results: There were 1461 studies identified in the search, of which 60 studies were eligible for data extraction. There were 11 common visual elicitation stimuli used across 51 studies. Stimuli used to elicit narratives ranged from single pictures to a 26-page storybook. The Flowerpot Incident, a 6-image black and white picture sequence, was used in more studies than any other image, but overall the most common format was wordless picture book. These materials originated from four sources: 1) tasks designed for people with aphasia; 2) adapted children’s storybooks, some with original text removed; 3) visual materials from a second language learning resource book; and 4) tasks designed for purpose for people with TBI. The study identified that macrostructural analyses were reported in use in most studies, however there were variations in terminology for analysis constructs across studies. One of the key shortcomings identified from this review was the limited discussion around content acceptability and cultural relevance of narrative stimulus materials to the people who use them.

Conclusions: Research studies are using picture sequences or wordless storybooks to elicit discourse samples after TBI. This contrasts with a recent survey of clinical practice with discourse post-TBI, where a single image, The Cookie Theft, was most reported in use (Steel et al., 2024). Few studies reporting on narratives used stimulus materials designed for purpose for people with cognitive communication disorder after TBI. We discuss the relevance of findings in relation to INCOG guidelines (Togher et al., 2023) and SLP practice, and make recommendations for clinical and research future directions.

Background: People with acquired brain injury (ABI) often experience challenges in conversations. Upskilling communication partners in using supportive communication strategies can promote successful interactions and is recommended best practice. However, communication partner training research evidence is limited by small sample sizes and inadequate follow-up assessment to confirm outcome maintenance. Communication partners report challenges accessing communication partner training, but there is potential for online tools to increase access. This study focused on outcomes in a large sample of participants completing a self-guided online program called interact-ABI-lity, designed to improve confidence and knowledge of communication partners of people with ABI.

Methods: This study used a prospective case series design to evaluate the impact of interact-ABI-lity. A mixed methods approach was used including a demographics questionnaire, a confidence and knowledge questionnaire (administered pre, post and at 3-month follow-up), and open-ended questions regarding use of course content and recommendations for course improvement. Quantitative data were analysed with Related-Samples Wilcoxon Signed Rank Tests. A descriptive content analysis of qualitative data was conducted.

Results: Between February 2023-April 2024, 851 individuals agreed to participate, and 369 participants (43%) completed interact-ABI-lity in full and completed the post-training questionnaire. A total of 38 participants completed the 3-month follow-up questionnaire. There was a significant increase from pre-intervention to post-intervention in self-reported confidence in interacting with people with ABI (pre: median rating = 3/5, post: median rating = 4/5, p < .001). Confidence was maintained at 3-month follow-up (p = .81). Evaluation of outcomes relating to knowledge of communication strategies is currently in progress. Qualitative analysis found that participants described the impact of training on their interactions, and perceived the content to be relevant. They reported sharing their learning from the course with others. Participants also identified valued components of the training and recommendations for improvement.

Discussion: The quantitative and qualitative data in this study provide preliminary evidence for the usefulness of interact-ABI-lity in training communication partners to successfully interact with people with ABI. The strengths of this study include a large participant sample with evidence of maintenance of outcomes over time. However, there was a low retention rate of participants at 3-months follow-up, and the validity of the outcome measures used in this study has not been established. Further research is needed to identify valid outcome measures suitable for use for evaluating knowledge and confidence of communication partners, and to strengthen the evidence for interact-ABI-lity using a randomized controlled trial.

Background: Social media can be challenging for people with an acquired brain injury (ABI) to use meaningfully and safely. A pilot study presented at the IBIA World Congress in 2023 found the multicomponent social-ABI-lity intervention to be feasible and acceptable, and participants reported improvements in confidence and enjoyment using a clinician-moderated Facebook group for social connection. However, given the potential benefits of peer-moderated interventions, we wanted to explore the feasibility and acceptability of the intervention when facilitated by peer moderators. This study evaluated the outcomes of conducting the multi-component intervention with a peer-moderated Facebook group, from the perspectives of both the participants and the peer moderators.

Methods: A mixed-methods, pre-post intervention design was used. Two people with ABI joined the research study as co-investigators and peer-moderators. Peer moderators completed a 2-hour training session, and roles and responsibilities were discussed and negotiated with other members of the research team prior to commencing the Facebook group. Participants completed the self-guided social-media course (social-ABI-lity), and then were encouraged to engage in the private, peer-moderated Facebook group over an 8-week period. Data were collected through observation of Facebook group activity, weekly surveys, and a post-intervention interview. Data were also collected on social media use and quality of life at pre-intervention, post-intervention, and 3 months post-intervention. Descriptive analysis was conducted for participant characteristics, social media use, social media knowledge, and social media engagement. Statistical analysis was used to compare measures for quality of life and reported ratings of frequency, confidence, and enjoyability of Facebook use. Thematic analysis was conducted on interview data, using an iterative process that incorporated an auto-ethnographic approach.

Results: Seven adults with an ABI completed the 8-week intervention, reporting improved confidence and enjoyment in using Facebook. The intervention was found to be acceptable, engaging, and feasible. Although there were no significant changes in quality of life, participants reported multiple benefits from the intervention. Our thematic analysis generated eight themes: loss, isolation, return, confidence, choice, identity, connection to community, and the ‘peer’ effect. Peer moderators observed that participants felt safe and supported by others with lived experience, which meant they felt more comfortable taking risks, making mistakes, and ‘putting themselves out there’. This reinforced sense of belonging encouraged everyone to take social risks, knowing that there was a safety net of understanding and empathy. Being involved also had a positive influence on the confidence and sense of self-identity of peer moderators.

Conclusion: This multicomponent social-ABI-lity intervention was the first of its kind. New insights relating to the peer-moderated group component of this subsequent pilot study will be discussed and contrasted with those of the clinician-led pilot study. Future implementation studies are warranted to determine usefulness and sustainability of this intervention in clinical practice.