Using Discourse Rating Scales to Measure Effectiveness of Treatment in People with Aphasia

Abstract

Improving discourse is often targeted in aphasia treatment because it is an important skill for meaningful conversation and interaction. The aphasia literature offers a variety of methods to analyze and treat discourse impairments in aphasia, however, there is no true consensus on what the best method is for discourse analysis. Very few studies have utilized listener perception as a method to capture discourse-related changes in aphasia. However, many researchers in other areas of speech-language pathology (e.g. dysarthria, fluency) use listener perceptions and rating scales as a valid measure to assess connected speech. The overarching goal of this study is to determine whether people with aphasia (PWA) and naïve listeners perceive changes in discourse associated with conversational treatment. A questionnaire, the Discourse Rating Scale for Aphasia, was created based on three constructs of discourse analysis in aphasia: macrolinguistic, microlinguistic, and functional features. Six PWA and nine naïve listeners listened to 30-35 second speech samples obtained before and after conversational treatment and rated their judgments on the questionnaire. We examined the relationship between the ratings on the Discourse Rating Scale for Aphasia (DRSA) and standardized language tests to validate the items and rating scale. Additionally, we looked for descriptive pre and post differences within the data to determine whether the DRSA was sensitive to treatment. It was found that each item and total DRSA score correlated highly with standardized tests of language in aphasia. We did not find strong evidence for the DRSA’s sensitivity to treatment; however, we discuss the clinical implications of utilizing listener perception in the assessment of discourse in aphasia.