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Behavioral trajectories of connected speech recovery in aphasia in the first year after stroke

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Poster B50 in Poster Session B, Tuesday, October 24, 3:30 - 5:15 pm CEST, Espace Vieux-Port

Marianne Casilio1, Jillian L Entrup1, Sarah M Schneck1, Caitlin Onuscheck1, Deborah F Levy1, Michael de Riesthal1, Stephen M Wilson1; 1Vanderbilt University Medical Center

Although longitudinal studies have shown overall aphasia recovery after stroke to be dynamic and multidimensional [1–3], the recovery of connected speech—that is, contextualized language production—remains poorly understood. The purpose of the present study was to characterize the behavioral trajectories of connected speech in aphasia in the first year after stroke. Leveraging a large longitudinal study [3], we extracted connected speech samples from 52 patients diagnosed acutely with aphasia following left-hemisphere stroke and tested at four key timepoints—2–5 days (T1), 1 month (T2), 3 months (T3), and 12 months (T4) post-onset. Samples were scored by a speech-language pathologist blinded to other data using the Auditory-Perceptual Rating of Connected Speech in Aphasia (APROCSA) [4], a reliable and validated scheme for the assessment of connected speech that yields scores on four profiles: Paraphasia (misselection of words and sounds), Logopenia (paucity of words), Agrammatism (morphosyntactic omissions), and Motor speech (impaired motor speech programming or execution). Change in connected speech over time was then quantified with growth curve modeling in a mixed effects framework. Specifically, repeated measures of the four APROCSA profile scores were modeled as a function of a fixed effect for time and a random effect for time varying across patients. Fixed and random intercepts were also included. The fixed effect of time was expressed as a categorical variable (reference=T1), which imposes no distributional assumptions about the shape of change, and APROCSA profile scores were standardized prior to analysis. Similar to prior work [1–3], scores on all APROCSA profiles followed an improving yet decelerating trajectory, with impairment lessening over time, and T1 scores were highly influential on the magnitude of change (Paraphasia: r=-.47, Logopenia: r=-.84, Agrammatism: r=-.74, Motor speech: r=-.83). By the end of the first year of recovery (T4), Logopenia scores had improved the greatest amount (β=-1.39±0.14, t=-10.29, p<.001), followed by Agrammatism (β=-1.25±0.15, t=-8.63, p<.001), Motor speech (β=-1.14±0.16, t=-7.21, p<.001), and Paraphasia (β=-0.97±0.13, t=-7.52, p<.001). This divergence between Logopenia and Paraphasia in mean rate change of recovery likely reflects the degree of functional specificity within the language network. Specifically, the features defining the Paraphasia profile (e.g., phonemic paraphasias, paragrammatism) are uniquely tied to damage in the posterior temporal lobe [5], a region not easily substituted by other language areas over the course of recovery [3]. In contrast, the Logopenia profile is associated with damage to multiple brain regions [5], suggesting that its features (e.g., abandoned utterances, pauses within utterances) have sufficient anatomical redundancy to support more effective functional recovery. In future, we plan to quantify the influence of structural brain damage on the behavioral trajectories of the present study, with the goal of developing a comprehensive account of connected speech recovery after stroke. [1] Kertesz, McCabe. Brain. 1977;100:1-18. [2] Stefaniak et al. Brain. 2022;145(4): 1354-1367. [3] Wilson et al. Brain. 2023;146(3):1021-39. [4] Casilio et al. Am J Speech Lang Pathol. 2019;28(2):550-568. [5] Casilio et al. Clinical Aphasiology Conference; 2023.

Topic Areas: Disorders: Acquired, Language Production

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