Articles by Richard K Peach
Aphasiology, 2024
Background: Numerous studies have investigated the effects of word frequency (WF), age of acquisi... more Background: Numerous studies have investigated the effects of word frequency (WF), age of acquisition (AoA), and animacy on picture naming in volunteers and those with aphasia. But none have controlled for any possible interactions among these three variables during noun retrieval and whether WF and AoA influence verb retrieval in ways that are similar to that observed during noun retrieval. Aims: The main purpose of this study was to examine the influences of WF, AoA, and animacy on noun retrieval in both volunteers and participants with aphasia and to compare these results to the effects of AoA and WF in both groups during verb retrieval. Methods and Procedures: A factorial approach was used to study the effects of (a) WF, AoA, and animacy on picture naming for 249 nouns, and (b) the effects of WF and AoA on picture naming for 88 verbs. Fifteen volunteers with no history of neurologic or psychiatric impairment and 13 people with aphasia participated in this study. Naming latencies using key press procedures were used to assess the effects of the independent variables. Linear mixed effects with random intercepts were modeled to analyze the results. Outcomes and Results: Nouns with early AoA and high WF were named significantly faster than all nouns with late AoA. There were no differences between naming speeds for animate vs. inanimate nouns. Animate nouns with early AoA and high frequency were named significantly faster than early, animate nouns with low frequency. Low word frequency facilitated naming by the participants with aphasia for early AoA verbs but slowed the volunteers' naming for these verbs. Participants responded significantly faster to nouns versus verbs regardless of AoA and WF. Conclusions: Controlling for animacy in noun picture naming produces novel findings regarding the effects of WF and AoA on word retrieval. The interaction among WF, AoA, and animacy is more consequential for picture naming speed than the specific effects of any one of these variables alone.
Language, Cognition, and Neuroscience, 2021
Research suggests that coherence processing of narratives produced by speakers with traumatic bra... more Research suggests that coherence processing of narratives produced by speakers with traumatic brain injury is dissociated from processing of inter-sentential cohesion and intra-sentential production. The goal of this study was to investigate the relationships between microlinguistic abilities and macrolinguistic operations in narratives produced by individuals with TBI. Narratives with variable story grammar were analysed for co-occurring instances of correct and erroneous cohesive ties, sentence pausing, and mazing to determine the relationships among global coherence, inter-sentential cohesion, and intra-sentential production. Story grammar was predicted by both increased inter-sentential cohesion and increased pausing within sentences. Logistic regression classified the completeness of the story episodes with 94% accuracy based on inter-sentential cohesion and sentence pausing. The results support a resource model of discourse processing where executive disturbances that impair the way individuals with TBI recruit and control cognitive resources result in deficits in multiple levels of discourse processing during narrative construction.
Journal of Speech, Language, and Hearing Research, 2019
Purpose: This study was conducted to examine the comparative effectiveness of 2 different approac... more Purpose: This study was conducted to examine the comparative effectiveness of 2 different approaches, 1 domain-specific and the other domain-general, to language and attention rehabilitation in participants with stroke-induced aphasia. The domain-specific treatment consisted of language-specific attention treatment (L-SAT), and the domain-general treatment consisted of direct attention training (DAT) using the computerized exercises included in Attention Process Training-3 (Sohlberg & Mateer, 2010). Method: Four individuals with mild-moderate aphasia participated in this study. A randomized controlled cross-over single-subject design was used to assess the effectiveness of the 2 treatments administered in this study. Treatment outcomes were evaluated in terms of participants' task performance for each program, standardized language and attention measures, tests of functional abilities, and patient-reported outcomes. Results: Visual comparisons demonstrated linear improvements following L-SAT and variable patterns following DAT. Omnibus effect sizes were statistically significant for 9 of the 13 L-SAT tasks. The weighted standardized effect sizes for posttreatment changes following L-SAT ranged from small to large, with the exception of 1 task. The average group gain following DAT was 5%. The Western Aphasia Battery-Revised Aphasia Quotients (Kertesz, 2007) demonstrated reliable improvements for 3 of the 4 participants following L-SAT, whereas only 1 of the participants improved reliably following DAT. The margins of improvements in functional language were substantially larger following L-SAT than DAT. Performance on the Test of Everyday Attention improved significantly for 2 participants following L-SAT and for 1 participant following DAT on selected Test of Everyday Attention (Robertson, Ward, Ridgeway, & Nimmo-Smith, 1994) subtests. Patient-reported outcomes for communication and attention following treatment favored L-SAT compared to DAT. Conclusions: The results support the view that attention is allocated in ways that are particular to specific tasks rather than as a general resource that is allocated equivalently to all processing tasks. Domain-specific treatment for language deficits due to attentional impairment appears to be a suitable, if not preferable, approach for aphasia rehabilitation. Supplemental Material: https://doi.org/10.23641/asha. 8986427
Journal of Speech, Language, and Hearing Research, 2019
Present the line drawings (Baseline_Probe PPT-Slides 2-41) on a computer monitor. Ask the patient... more Present the line drawings (Baseline_Probe PPT-Slides 2-41) on a computer monitor. Ask the patient to name each picture as quickly as possible (maximum equals 20 seconds). Score correct and incorrect responses.
Aphasiology, 2018
Background: Multiple language problems have been attributed to attentional impairments in people ... more Background: Multiple language problems have been attributed to attentional impairments in people with aphasia. As a result, a number of investigations have examined the effectiveness of attentional treatments for improving impaired language processing. With few exceptions, all of the studies have used domain-general (nonspecific) attention training with nonlinguistic tasks as the therapeutic modality. Unfortunately, despite the well-documented associations between language and attention, these treatments have not yielded substantial improvements in language outcomes. It may be that the lack of specificity in these approaches for recruiting language-related attentional processes is a contributing factor. To address this issue, a Language-Specific Attention Treatment (L-SAT) (Peach, 2012) was proposed using language tasks that are purported to recruit attention for language processing. Further investigation into the attentional requirements of these tasks is needed. Aims: To establish the construct validity and reliability of the baseline and probe tasks (hereafter, probe tasks) used in L-SAT in a group of healthy participants as well as to determine the external validity of these tasks in participants with aphasia. Methods & Procedures: Twenty healthy participants and six participants with aphasia were assessed using standardized language and attention tests and an experimental battery of eight language-specific attention tasks that serve as the probe measures for this program. Correlational analyses were performed to examine the construct and external validity of the experimental tasks as well as their reliability.
Seminars in Speech and Language, 2017
Seminars in Speech and Language , 2017
The need for a specific, language-based treatment approach to aphasic impairments associated with... more The need for a specific, language-based treatment approach to aphasic impairments associated with attentional deficits is well documented. We describe language-specific attention treatment, a specific skill-based approach for aphasia that exploits increasingly complex linguistic tasks that focus attention. The program consists of eight tasks, some with multiple phases, to assess and treat lexical and sentence processing. Validation results demonstrate that these tasks load on six attentional domains: (1) executive attention; (2) attentional switching; (3) visual selective attention/processing speed; (4) sustained attention; (5) auditory-verbal working memory; and (6) auditory processing speed. The program demonstrates excellent inter-and intrarater reliability and adequate test-retest reliability. Two of four people with aphasia exposed to this program demonstrated good language recovery whereas three of the four participants showed improvements in auditory-verbal working memory. The results provide support for this treatment program in patients with aphasia having no greater than a moderate degree of attentional impairment. Learning Outcomes: As a result of this activity, the reader will be able to (1) discuss the attentional requirements for language processing; (2) list language deficits that arise from attentional impairments following aphasia; (3) describe a language-specific attention treatment for remediating deficits in language and attention associated with aphasia.
Aphasiology , Mar 4, 2016
Background: Recent legislation in the United States has called for greater use of patient-reporte... more Background: Recent legislation in the United States has called for greater use of patient-reported outcomes to assess treatment effectiveness. Life satisfaction is a patient-reported outcome that is only recently receiving attention in the aphasia literature. Understanding life satisfaction among persons with aphasia (PWA) is critical to developing strategies that will assist these individuals in managing their lives after experiencing aphasia. Aims: The aim of this paper is to review life satisfaction among PWA for the purpose of stimulating further discussion and research. Main Contribution: We identified five studies with mixed results relating to life satisfaction after aphasia. Understanding life satisfaction among PWA is important as it reflects the individual's response to this life changing communication disorder. However, the influence of a range of issues remains unclear with regard to life satisfaction and aphasia, including (a) the contributions of the individual's clinical and sociodemographic characteristics, (b) the effects of time and (c) the methods used for measuring life satisfaction after aphasia. This review explores the complex factors associated with life satisfaction after aphasia. Conclusions: Studies of life satisfaction among PWA are lacking. Much needs to be learned about the range of factors associated with life satisfaction after aphasia. Understanding these issues is key to facilitating optimal post-aphasia outcomes from the perspective of the patient.
Neuropsychologia, Nov 22, 2016
Some suggest that traumatic brain injury (TBI) produces dissociation between the macrolinguistic ... more Some suggest that traumatic brain injury (TBI) produces dissociation between the macrolinguistic and microlinguistic levels of discourse production. This assumption is based primarily on studies that have found preserved intersentential cohesion and/or intra-sentential processing in narratives produced by these individuals. However, few studies exist, if any, that have investigated the relationship between these processes in TBI speakers who do demonstrate such microlinguistic impairments. This study investigated the relationship between impairments of intersentential cohesion and intra-sentential processing in the discourse of 15 speakers with severe TBI. The results demonstrated a significant relationship between the production of cohesive ties and instances of intra-sentential impairment that suggests that utilization of resources for adequate cohesion appears to negatively affect intra-sentential processing following TBI. We propose that macrolinguistic and microlinguistic processes are not independent of one another, as has been proposed, but share cognitive resources that support the planning and production of both local (microlinguistic) and long-distance (macrolinguistic) relationships expressed through discourse.
American Journal of Speech-Language Pathology, 2013
Analyses of language production of individuals with traumatic brain injury (TBI) place increasing... more Analyses of language production of individuals with traumatic brain injury (TBI) place increasing emphasis on microlinguistic (i.e., within-sentence) patterns. It is unknown whether the observed problems involve implementation of well-formed sentence frames or represent a fundamental linguistic disturbance in computing sentence structure. This study investigated the cognitive basis for microlinguistic deficits in individuals with TBI. Fifteen nonaphasic individuals with severe TBI and 6 age- and education-matched non brain-injured adults participated in this study. Monologic discourse samples were analyzed for pausing patterns, mazes, errors, and abandoned utterances. Measures of cognitive abilities were correlated with the sentence measures. The speakers with TBI produced more pauses between clauses (but not within clauses) as well as more mazes than did the non brain-injured speakers. Significant regression models were built. Raven's Coloured Progressive Matrices (Raven, 1965), a measure associated with working memory, predicted pause behavior, and Likenesses-Differences (Baker & Leland, 1967), a measure of executive function, predicted maze behavior. Sentence planning impairments following TBI are associated with deficient organization and monitoring of language representations in working memory. These findings suggest that the deficits are due to problems in the recruitment and control of attention for sentence planning. These findings bear on sentence processing models that emphasize the activation, organization, and maintenance of language representations for accurate sentence production.
Aphasiology, Sep 16, 2009
Background: Semantic feature analysis (SFA) is a prominent treatment for the word retrieval defic... more Background: Semantic feature analysis (SFA) is a prominent treatment for the word retrieval deficits of aphasia. Generalisation of improved word retrieval on picture naming to discourse production has been an important factor for evaluating the effectiveness of SFA treatment. Unfortunately, generalisation of word retrieval improvements to discourse production following SFA has been modest.Aims: Because of the previous, albeit limited, success
NeuroRehabilitation, 2009
Current descriptions of the language problems following traumatic brain injury (TBI) generally em... more Current descriptions of the language problems following traumatic brain injury (TBI) generally emphasize evaluating discourse production and explaining the observed outcomes in terms of disruptions to executive processes. The notion of sentence production impairments at the sentence level has generally been ignored. To respond to this issue, we examined patterns of intrasentential pausing and sentence planning during sentences produced by normal and TBI speakers. Seven individuals with TBI functioning at Rancho Level V-VI and seven age-matched controls participated in this pilot experiment. Group performances were compared for pause time and verbal initiation time during the production of sentences varying in syntactic complexity under two conditions (reading and repetition). Significant group differences were observed in pausing during both conditions. Pausing patterns of the participants with TBI were strongly correlated with the syntactic complexity of sentences. No significant g...
International Journal of …, Jan 1, 2009
The psychosocial impact of acquired dysarthria on the speaker is well recognized. To date, speech... more The psychosocial impact of acquired dysarthria on the speaker is well recognized. To date, speech-and-language therapists have no instrument available to measure this construct. This has implications for outcome measurement and for planning intervention. This paper describes the Dysarthria Impact Profile (DIP), an instrument that has the potential to meet this need in clinical practice. To describe the development of the DIP, which was devised as part of a larger study to measure psychosocial impact of acquired dysarthria from the speaker's perspective. The current psychometric properties of the DIP are examined. The scale was administered to 31 participants with acquired dysarthria. The internal consistency of the scale items and their intra-rater reliability were investigated. Concurrent validity was assessed for the portion of the scale (Section A) assessing impact of acquired dysarthria on self-perception, self-concept and self-esteem by comparing the results with changes in self-concept as determined by the Head Injury Semantic Differential Scale (HISD II). The DIP shows good internal consistency and strong intra-rater reliability overall. There was a strong, statistically significant, correlation between results on Section A of the DIP and the results of the HISD II suggesting convergent validity for this portion of the scale. There are some limitations to the scale in its current format and these are highlighted. The scale is now ready for further refinement and development. Once validated, it should act as a robust outcome measure for clinicians.
American Journal of Speech-Language Pathology, 2007
Purpose: To document and describe in detail the occurrence of apraxia of speech (AOS) in a group ... more Purpose: To document and describe in detail the occurrence of apraxia of speech (AOS) in a group of individuals with a diagnosis of motor neuron disease (MND).
Method: Seven individuals with MND and AOS were identified from among 80 patients with a variety of neurodegenerative diseases and AOS (J. R. Duffy, 2006). The history, presenting complaints, neurological findings, and speech language
findings were documented for each case.
Results: Spastic or mixed spastic-flaccid dysarthria was present in all 7 cases. The AOS was judged as worse than the dysarthria in 4 cases. Nonverbal oral apraxia was eventually present in all cases. Aphasia was present in 2 cases and
equivocally present in another 2. Dementia was present in 1 case and equivocally present in 2.
Conclusions: AOS can occur in MND, typically also with dysarthria, but not invariably with aphasia or other cognitive deficits. Thus, a diagnosis of MND does not preclude the presence of AOS. More importantly, MND should be a diagnostic consideration when AOS is a prominent sign of degenerative disease.
Paper presented to the annual meeting of the Clinical Aphasiology Conference, Ghent, Belgium, 2006
Topics In Stroke Rehabilitation, 2004
The features of apraxia of speech (AOS) are presented with regard to both traditional and contemp... more The features of apraxia of speech (AOS) are presented with regard to both traditional and contemporary descriptions of the disorder. Models of speech processing, including the neurological bases for apraxia of speech, are discussed. Recent findings concerning subcortical contributions to apraxia of speech and the role of the insula are presented. The key features to differentially diagnose AOS from related speech syndromes are identified. Treatment implications derived from motor accounts of AOS are presented along with a summary of current approaches designed to treat the various subcomponents of the disorder. Finally, guidelines are provided for treating the AOS patient with coexisting aphasia.
Journal of Communication Disorders, 2004
Reports describing subcortical apraxia of speech (AOS) have received little consideration in the ... more Reports describing subcortical apraxia of speech (AOS) have received little consideration in the development of recent speech processing models because the speech characteristics of patients with this diagnosis have not been described precisely. We describe a case of AOS with aphasia secondary to basal ganglia hemorrhage. Speech-language symptoms consistent with subcortical AOS and aphasia are reported as well as description of the patient's speech characteristics using broad phonemic transcription. Significantly more phoneme substitution errors were observed than other types of errors and these occurred significantly more often in the initial rather than the medial or final positions of words. No differences were observed in the number of errors produced for the various types of phonemes included in this analysis. These findings challenge the hypothesis that speech motor planning disorders are uniquely the result of cortical damage. They also argue against the notion that subcortical AOS is indistinguishable from the cortical syndrome. The reader will learn (1) the phonemic characteristics of AOS due to subcortical brain damage, (2) the similarities and differences between AOS due to cortical versus subcortical lesions, and (3) the implications of these patterns for current models of speech motor processing.
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Articles by Richard K Peach
Method: Seven individuals with MND and AOS were identified from among 80 patients with a variety of neurodegenerative diseases and AOS (J. R. Duffy, 2006). The history, presenting complaints, neurological findings, and speech language
findings were documented for each case.
Results: Spastic or mixed spastic-flaccid dysarthria was present in all 7 cases. The AOS was judged as worse than the dysarthria in 4 cases. Nonverbal oral apraxia was eventually present in all cases. Aphasia was present in 2 cases and
equivocally present in another 2. Dementia was present in 1 case and equivocally present in 2.
Conclusions: AOS can occur in MND, typically also with dysarthria, but not invariably with aphasia or other cognitive deficits. Thus, a diagnosis of MND does not preclude the presence of AOS. More importantly, MND should be a diagnostic consideration when AOS is a prominent sign of degenerative disease.
Method: Seven individuals with MND and AOS were identified from among 80 patients with a variety of neurodegenerative diseases and AOS (J. R. Duffy, 2006). The history, presenting complaints, neurological findings, and speech language
findings were documented for each case.
Results: Spastic or mixed spastic-flaccid dysarthria was present in all 7 cases. The AOS was judged as worse than the dysarthria in 4 cases. Nonverbal oral apraxia was eventually present in all cases. Aphasia was present in 2 cases and
equivocally present in another 2. Dementia was present in 1 case and equivocally present in 2.
Conclusions: AOS can occur in MND, typically also with dysarthria, but not invariably with aphasia or other cognitive deficits. Thus, a diagnosis of MND does not preclude the presence of AOS. More importantly, MND should be a diagnostic consideration when AOS is a prominent sign of degenerative disease.