Communicative value of self cues in aphasia: A re-evaluation

BACKGROUND: Adults with aphasia often try mightily to produce specific words, but their word-finding attempts are frequently unsuccessful. However, the word retrieval process may contain rich information that communicates a desired message regardless of word-finding success. AIMS: The original article reprinted here reports an investigation that assessed whether patient-generated self cues inherent in the word retrieval process could be interpreted by listener/observers and improve on communicative effectiveness for adults with aphasia. The newly added commentary identifies and reports tentative conclusions from 18 investigations of self-generated cues in aphasia since the 1982 paper. It further provides a rationale for increasing research on self-generated cueing and notes a surprising lack of attention to the questions investigated in the original article. The original research is also connected with more recent qualitative investigations of interactional, as opposed to transactional, communicative exchange. METHODS #ENTITYSTARTX00026; PROCEDURES: While performing single-word production tasks, 10 adults with aphasia produced 107 utterances that contained spontaneous word retrieval behaviours. To determine the "communicative value" of these behaviours, herein designated self cues or self-generated cues, the utterance-final (potential target) word was edited out and the edited utterances were dubbed onto a videotape. Six naïve observers, three of whom received some context about the nature of word retrieval in aphasia and possible topics for the utterances, and three of whom got no information, predicted the target word of each utterance from the word-finding behaviours alone. The communicative value of the self-generated cues was determined for each individual with aphasia by summing percent correct word retrieval and percent correct observer prediction of target words, based on word retrieval behaviours. The newly added commentary describes some challenges of investigating a "communicative value" outcome, and indicates what would and would not change about the methods, if we did the study today. OUTCOMES #ENTITYSTARTX00026; RESULTS: The observer group that was given some context information appeared to be more successful at predicting target words than the group without any such information. Self-generated cues enhanced communication for the majority of individuals with aphasia, with some cues (e.g., descriptions/gestures of action or function) appearing to carry more communicative value than others (e.g., semantic associates). The commentary again indicates how and why we would change this portion of the investigation if conducting the study at this time. CONCLUSIONS: The results are consistent with Holland's (1977) premise that people with aphasia do well at communication, regardless of the words they produce. The finding that minimal context information may assist observers in understanding the communicative intent of people with aphasia has important implications for training family members to interpret self-generated cues. The new commentary reinforces these conclusions, highlights potential differences between self cues that improve word-finding success and those that enhance message transmission, and points to some additional research needs.