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Determinants of Multilevel Discourse Outcomes in Anomia Treatment for Aphasia

Cavanaugh, Robert (2023) Determinants of Multilevel Discourse Outcomes in Anomia Treatment for Aphasia. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Communication is fundamental to the human condition but is impaired in life-altering ways for more than 2.4 million individuals with aphasia in the United States. Individuals with aphasia identify discourse-level communication (i.e. language in use) as a high priority for treatment. The central premise of most aphasia treatments is that restoring language at the phoneme, word, and/or sentence level will generalize to discourse. However, treatment-related changes in discourse-level communication are modest, poorly understood, and vary greatly between individuals with aphasia. In response, this study conducted a multilevel discourse analysis of archival, monologic discourse outcomes across two high-intensity Semantic Feature Analysis clinical trials (combined n = 60). First, we evaluated improvement on theoretically motivated discourse outcomes representing lexical-semantic processing, lexical diversity, grammatical complexity, and discourse informativeness across study enrollment, entry, exit, and 1 month follow-up. Second, we examined the potential moderating role of non-language cognitive factors (semantic memory, divided attention, and executive function) on discourse outcomes in a subsample of participants (n = 44). The present study found no evidence for meaningful or statistically reliable improvements in monologue discourse performance after Semantic Feature Analysis. There was weak and inconsistent evidence that non-language cognitive factors may play a role in moderating treatment response. While improving discourse-level communication may help to reduce the profound communication and psychosocial consequences of aphasia, these findings indicate that intentional treatment design with a focus on generalization to discourse is likely necessary to meaningfully improve discourse-level communication in aphasia in both research and clinical practice.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Cavanaugh, Robertrob.cavanaugh@pitt.eduroc790000-0002-2114-6565
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairEvans, William Streicherwie6@pitt.eduwie60000-0001-5124-3473
Committee MemberDickey, Michael
Committee MemberHula, William
Committee MemberFromm,
Date: 11 July 2023
Date Type: Publication
Defense Date: 17 April 2023
Approval Date: 11 July 2023
Submission Date: 9 May 2023
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 148
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Communication Science and Disorders
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Aphasia Treatment Discourse
Date Deposited: 11 Jul 2023 15:43
Last Modified: 11 Jul 2023 15:43


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