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Addressing Aphasia
Addressing Aphasia

The ability to communicate symbolically is one of the defining characteristics of our species. Language is fundamental to how we form and maintain social groups and transmit knowledge over time. Most of us use language effortlessly. For some, however, whose use of language is impaired, it may be difficult, if not impossible to say what you mean. That is the experience faced by more than 200,000 Americans who acquire the communication disorder known as aphasia each year.

According to the National Aphasia Association, aphasia “impairs a person’s ability to process language, but does not affect intelligence.” It is brought on when the brain’s language networks are damaged, most often as the result of stroke, although any kind of traumatic brain injury can result in aphasia.

Assistant Professor Gerasimos Fergadiotis of the Department of Speech and Hearing Sciences at Portland State University is a Speech-Language Pathologist and researcher whose work focuses on language processing in aphasia and cognitive assessment. Specifically, Dr. Fergadiotis investigates how aging affects the ways we process language, assess the efficacy of treatments for aphasia, and develops innovative new tools to diagnose aphasia by type and severity.

Outside the lab, Dr. Fergadiotis serves on the American Speech Language and Hearing Association and its committee charged with developing Affordable-Care-Act-mandated “patient reported outcomes” performance measurement materials that will be implemented in speech-language and hearing pathology settings throughout the U.S. Dr. Fergadiotis also sits on the board of the Aphasia Network, a Portland-based nonprofit organization that supports the population of persons with aphasia.

“Broadly speaking, my work aims to improve quality of life for individuals with language impairments,” Dr. Fergadiotis said. “However, in the Aging and Adult Language Disorders Lab we have a dual focus. Our primary goal is to develop assessment tools for people with aphasia. Our second line of research investigates the ways healthy, older adults process language in order to learn more about why the ability to communicate begins to decline in our late 60s and early 70s.”

In a project Dr. Fergadiotis is developing with the support of a Faculty Enhancement Grant from PSU’s office of Research and Strategic Partnerships, he and his students are quantifying different aspects of language processing in healthy, older adults: the working memory, executive functions, and cognitive skills needed to effectively communicate using language. Study participants are asked to perform tasks such as describing what they see in a picture, tell a story about what they did over the weekend or at some other time in the past, and take a position on, or make an argument for or against a controversial topic. These exercise provide a variety of the kind of everyday discourse one might here in the real world. Dr. Fergadiotis’ graduate students transcribe and analyze the data to assess its level of coherence.

“What we are looking for in the language samples from neurotypical, older adults,” Dr. Fergadiotis said, “is how well each sentence relates to the overall theme of what is being communicated. The ability to produce coherent discourse requires specific parts of the brain to work in unison. When telling a story or providing an opinion, a speaker needs to remember information in sequence. They have to choose the correct words. They need to maintain focus and attention. All of these different factors have to come together to produce meaningful discourse. If someone can’t do all these things, there might be a problem.”

Dr. Fergadiotis’ hypothesis is that there are likely mediating circumstances involved in how older adults process language. To learn more he’s questioning the role psychosocial factors play in our ability to communicate coherently. Do social ties and activities—talking regularly with friends or family, going places and doing things with others, etc.—mitigate the effects of aging on language processing? If so, is there a way to qualitatively and quantitatively show that they do in reproducible studies?

The answers to these questions and others like that could help researchers and speech-language pathologists like Dr. Fergadiotis develop tools older adults may one day use to sharpen the cognitive skills necessary to communicate effectively later in life. With extending life expectancies and aging populations, such innovations would undoubtedly improve the quality of life for millions of older adults in the US and around the world.

For those who have experienced stroke or other traumatic brain injuries, the ability to maintain the cognitive functions needed for effective communication may be less certain. However, the earlier a more precise a diagnosis of aphasia is made, better are the chances that a speech-language pathologist can prescribe appropriate treatments that may lead to a partial or full recovery.

As Dr. Fergadiotis explained, there are a number of disadvantages to the diagnostic tools now available to speech-language pathologists. Current diagnostic methodologies involve working with patients who are often in hospitals having recently experienced serious brain injuries. In order to determine the nature of the underlying cognitive deficits and severity of a patient’s condition, speech-language pathologists must administer long tests (Dr. Fergadiotis noted one with 175 questions) in which patients are asked to identity objects in pictures. While the tests are effective, they require far too much time and can be frustrating to patients depending on whether they’re experiencing aphasia and to what degree. Dr. Fergadiotis’ innovative solution, which he is working on in collaboration with researchers at the Veterans’ Affairs hospital in Pittsburg, Pennsylvania, is to apply computer adaptive testing as a tools to diagnose aphasia.

“Computer adaptive testing is the operating principle behind the Graduate Records Examinations and similar tests,” Dr. Fergadiotis explained. “When someone takes the GRE, the software proctoring the test asks a question and determines the line of questioning to follow based on answers provided. We are creating algorithms that apply the same principles to diagnosing cases of aphasia. The test responds to the patient’s ability level, which saves time, aggravation, and improves patient outcomes.”

According to Dr. Fergadiotis, he and his collaborators have used their software to cut the number of questions a speech-language pathologist needs to ask to make an assessment from 175 to 30. Thus far their success rate show the algorithm to be 96 percent as effective as the longer test. The promise shown by the new diagnostic tool prompted the submission of a grant proposal to the National Institutes of Health that if funded will move the project into the next phase of testing and development.

Now in his third year at PSU, Dr. Fergadiotis is one of a growing number of faculty working on issues related to communication. Departments including Speech and Hearing Sciences, the Graduate School of Education, and the School of Social Work are adding to the university’s portfolio of research that is improving the quality of life for those with disorders that impair their ability to communicate. Whether it is developing methods to diagnose aphasia, assessments to measure the efficacy of interventions and treatments, or using technology to create innovative ways to augment how communication is carried out, these researchers are laying groundwork for a more inclusive approach to how we connect with one another through language.