A Clinical Training Program for Auditory-Perceptual Rating of Connected Speech in Aphasia

Although discourse analysis has been receiving growing interest among aphasia researchers and speech-language pathologists (SLPs), several key challenges, such as limited time, insufficient training, and a lack of accessible tools, preclude its practical application in clinical settings. To address these barriers, we developed and evaluated a clinical training program for Auditory-Perceptual Rating of Connected Speech in Aphasia (APROCSA; Casilio et al., 2019), a time-efficient and psychometrically robust transcriptionless system for quantifying a range of speech-language impairment features.

A collaborative working group was established, comprising five researchers with expertise in discourse analysis in aphasia and eight SLPs who actively worked with individuals with aphasia in clinical or research roles. Through this partnership, SLP members provided feedback regarding their training needs, which informed the creation of a comprehensive training program that included a manual, webinar, and hybrid training sessions. Program effectiveness was measured by comparing SLPs' interrater agreement on six discourse samples before and after the training relative to expert consensus ratings, as well as posttraining perceptions on the program. Adoption of APROCSA into SLPs' work settings at approximately 1 year posttraining was also quantified.

Interrater agreement improved as a function of training and newer clinicians appeared to benefit the most from the training. Posttraining perceptions were complementary to the interrater agreement findings, with nearly all SLPs indicating that the training was very helpful. At 1 year posttraining, most SLPs reported using APROCSA, primarily for assessment purposes, highlighting its effectiveness in helping them characterize spoken discourse in clinical contexts.

The APROCSA training program addresses key barriers to implementation, with preliminary evidence supporting its effectiveness and adoption into clinical work settings. Results overall support APROCSA's feasibility in clinical use and emphasize the benefits of targeted training for clinical discourse assessment.