Phase I test development for a brief assessment of transactional success in aphasia: methods and preliminary findings of main concepts in non-aphasic participants

Background One obstacle for clinicians and third-party payers embracing a participation-based framework for assessing and treating aphasia is the dearth of clinically convenient instruments for measuring change in functional communication. Traditional assessments often do not capture subtle improvements in communicative success. However, analyzing conversation and other discourse is too labor intensive to be a useful, practical tool in clinical settings. Aims The purpose of this study was to acquire a set of story-retelling normative references from a sample of non-aphasic volunteers, and to develop checklists for the Brief Assessment of Transactional Success in conversation in aphasia (BATS). Methods & Procedures We examined 768 narratives from a sample of 96 healthy, non-aphasic volunteers from three age cohorts. We focus here on one macrolinguistic measure of discourse analysis, main concepts (MCs), that assesses a person's ability to convey a story's gist. Forty-eight narratives were elicited from each of 16 short video and/or audio stimuli from four categories that varied in the degree of reliance on auditory comprehension for story gist. Transcripts were analyzed for MCs using the methods of Richardson and Dalton (2016, 2020). Results Our analysis generated checklists, including essential elements of MCs that were produced by at least 33% of the normative sample, along with examples of alternative productions. Reference thresholds were established for "non-normal" scores falling below the 5% quantile in the ratio of an MC composite score to the number of MCs (MCComp/MCs). Similar to earlier studies, a younger third of participants produced narratives that were scored significantly higher in the ratio of MCComp/MCs. Whereas we have hypothesized that the non-verbal video stimuli would ultimately prompt the most accurate and complete narratives in aphasic narrative retells, in the current non-clinical sample, we expected and found that the narrated stimuli were more likely to elicit accurate and complete main concepts. Conclusions The next phase of development will involve testing the stimuli on a large clinical sample to acquire: 1) aphasic narratives; 2) topic-constrained conversations with non-aphasic conversation partners to establish intersubjectivity regarding story gist; and 3) conversation partner narratives. It is hoped that the BATS will become a popular, free, and accessible tool for clinicians and clinical researchers. Utilizing these short, engaging video/audio clips and checklists of MCs will help to narrow the chasm between standardized aphasia batteries and an elusive measure of communicative success.