A multi-level approach to the analysis of narrative language in aphasia

Background: Several studies have shown that traditional standardised aphasia tests may not be sensitive enough to adequately assess linguistic deficits and recovery patterns in persons with aphasia. As a result, both functional and structural methods for the analysis of connected language samples from people with aphasia have been devised (see Armstrong, 2000; Prins & Bastiaanse, 2004). Aims: The present article focuses on our attempt to provide a comprehensive, multi-level procedure for both structural and functional analysis of narrative discourse produced by speakers with brain damage. Accordingly, we will describe a method for analysis of connected language samples elicited on single picture and cartoon story description tasks. This method has proven sensitive in the assessment of language deficits in many neurogenic populations. Methods & Procedures: A comprehensive description of the language production system, a thorough discussion of the different approaches to discourse analysis in persons with aphasia, and the procedure for the analysis of narrative discourse are detailed. The characteristics of the eliciting stimuli, the procedures for their administration and the transcription of the language samples are carefully explained. The analysis focuses on four main aspects of linguistic processing: productivity, lexical and grammatical processing, narrative organisation, and informativeness. To further illustrate the analytic procedure, two case reports and an appendix with the analysis of a narrative sample are provided. Outcomes & Results: We will provide direct evidence of the usefulness of the multi-level procedure for discourse analysis for assessing changes in discourse performance of two persons with fluent aphasia, with different aetiologies, that were not captured by traditional standardised aphasia tests. Conclusions: The method of analysis presented in this paper has strong grounds in linguistic and psychological theories of linguistic structure and functioning. It also has the advantage of being both quantitative and functional as it captures selective aspects of linguistic processing, and can provide relevant information about the person's communicative and informative skills.