New approach may offer better ways to help stroke patients communicate

Often it’s not what you say, it’s what you understand that makes you a successful communicator.

With that premise in mind, speech and language researchers at Arizona State University's College of Health Solutions are testing an innovative way to help people who struggle with communication following a stroke. Rather than focusing on a patient’s ability to speak, they will instead conduct research to determine if the way speakers talk can improve a stroke patient’s ability to understand.

Arianna LaCroix, a speech-language pathologist and third-year doctoral student in the speech and hearing science program, has received a $50,000 predoctoral fellowship from the American Heart Association for her dissertation research on the role speech prosody, or the way people speak, plays in stroke patients’ ability to comprehend. Her adviser, Corianne Rogalsky, assistant professor of speech and hearing science and director of the Communication Neuroimaging and Neuroscience Laboratory, will supervise her study.

Little research exists on post-stroke patients’ speech comprehension abilities, but for LaCroix, this focus is key to successful rehabilitation.

“The ability to comprehend speech, not the ability to produce speech, is the number one predictor of quality of life after someone has a stroke,” she said.

Speech-language pathologists instinctively change the pitch and rhythm of their own speech when they work with their patients, and LaCroix wondered if speaking in certain ways would improve patients’ ability to comprehend.

To think about how this would sound, compare an overly dramatic actor performing a Shakespearean soliloquy to a monotone speaker reading from a grocery list. Because stroke affects each patient differently, depending on which area of the brain is damaged, LaCroix theorizes that speaking in an exaggerated way will help patients whose attention span is better, while those whose memory is better will understand more if they are spoken to in a flat, even tone.

By aligning the way of speaking with each patient’s cognitive strengths, LaCroix and Rogalsky hope to develop an individualized approach to speech therapy.

“One roadblock to speech-comprehension rehabilitation is substantial individual variability,” Rogalsky said. “In this project we are embracing these individual differences and using them to tailor changes in our speech to help the individual better understand what they are hearing.”

To test study participants’ memory and attention abilities, researchers will use a standard cognitive assessment as well as have them listen to recordings of sentences spoken with both exaggerated and monotone prosody. Participants will match the meaning of the sentences to corresponding pictures in a computer-based task to determine which method of speaking improves their comprehension. Then an MRI will measure the size and location of each patient’s brain lesions, hoping to correlate that data with the prosody that improved comprehension.

“It’s important to have this MRI data because lesion size and location may be more reliable in predicting which prosody manipulation may improve comprehension than just cognitive abilities,” LaCroix said.

Rogalsky agreed. “Compensation strategies are not necessarily beneficial to the same degree for everyone, and it can take months working with an individual to really get to know what works for them,” she said. “Our project aims to use information that is readily available to a clinician, such as brain scans and simple standard cognitive tests, to quickly identify what will be an optimal way to communicate with them.”

The study will last two years, with data collection in the first year and analysis and dissemination of results in the second year.