How Do Clinicians Judge Fluency in Aphasia?
Publication: Journal of Speech, Language, and Hearing Research
Volume 65, Number 4
Pages 1521-1542
Abstract
Purpose:
Aphasia fluency is multiply determined by underlying impairments in lexical retrieval, grammatical formulation, and speech production. This poses challenges for establishing a reliable and feasible tool to measure fluency in the clinic. We examine the reliability and validity of perceptual ratings and clinical perspectives on the utility and relevance of methods used to assess fluency.
Method:
In an online survey, 112 speech-language pathologists rated spontaneous speech samples from 181 people with aphasia (PwA) on eight perceptual rating scales (overall fluency, speech rate, pausing, effort, melody, phrase length, grammaticality, and lexical retrieval) and answered questions about their current practices for assessing fluency in the clinic.
Results:
Interrater reliability for the eight perceptual rating scales ranged from fair to good. The most reliable scales were speech rate, pausing, and phrase length. Similarly, clinicians' perceived fluency ratings were most strongly correlated to objective measures of speech rate and utterance length but were also related to grammatical complexity, lexical diversity, and phonological errors. Clinicians' ratings reflected expected aphasia subtype patterns: Individuals with Broca's and transcortical motor aphasia were rated below average on fluency, whereas those with anomic, conduction, and Wernicke's aphasia were rated above average. Most respondents reported using multiple methods in the clinic to measure fluency but relying most frequently on subjective judgments.
Conclusions:
This study lends support for the use of perceptual rating scales as valid assessments of speech-language production but highlights the need for a more reliable method for clinical use. We describe next steps for developing such a tool that is clinically feasible and helps to identify the underlying deficits disrupting fluency to inform treatment targets.
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Information & Authors
Information
Published In
Journal of Speech, Language, and Hearing Research
Volume 65 • Number 4 • April 2022
Pages: 1521-1542
PubMed: 35271379
Copyright
Copyright © 2022 American Speech-Language-Hearing Association.
History
- Received: Sep 9, 2021
- Revised: Dec 12, 2021
- Accepted: Dec 17, 2021
- Published online: Mar 10, 2022
- Published in issue: Apr 4, 2022
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- Jean K. Gordon, Sharice Clough, The Flu-ID: A New Evidence-Based Method of Assessing Fluency in Aphasia, American Journal of Speech-Language Pathology, 10.1044/2024_AJSLP-23-00424, 33, 6, (2972-2990), (2024).
- Lorraine Baqué, María-Jesús Machuca, Dysfluency in primary progressive aphasia: Temporal speech parameters, Clinical Linguistics & Phonetics, 10.1080/02699206.2024.2378345, (1-34), (2024).
- Davida Fromm, Steffi Chern, Zihan Geng, Mason Kim, Joel Greenhouse, Brian MacWhinney, Automated Analysis of Fluency Behaviors in Aphasia, Journal of Speech, Language, and Hearing Research, 10.1044/2024_JSLHR-23-00659, 67, 7, (2333-2342), (2024).
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- Lionel Fontan, Typhanie Prince, Aleksandra Nowakowska, Halima Sahraoui, Silvia Martinez-Ferreiro, Automatically measuring speech fluency in people with aphasia: first achievements using read-speech data, Aphasiology, 10.1080/02687038.2023.2244728, 38, 5, (939-956), (2023).
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