College of Public Health researchers have developed an advanced clinical test that they hope practitioners may soon use to assess stroke patients and work toward recovery of diminished speech abilities.
The Temple Assessment of Language and Short-Term Memory in Aphasia (TALSA) is for diagnosing people with aphasia, a language disorder often caused by stroke. It can impair a person’s ability to speak, write, or process incoming language, even though the person’s intellect and stored knowledge of language remain intact. There are around 100,000 new aphasia cases annually in the United States, and an estimated 2.5 million Americans are living with aphasia.
“TALSA is designed to augment assessment batteries that are out there already, but it incorporates the newest ideas about what aphasia is, and it can produce more sensitive results,” says Nadine Martin, who heads the Aphasia Rehabilitation Research Laboratory in the College of Public Health.
Martin’s team created a research version of TALSA in 2008. In 2017, Martin was awarded a five-year, $2.5 million grant from the National Institutes of Health to develop a clinical, digital version of TALSA, a product that speech pathologists could use in their practices to diagnose patients.
TALSA notably adds verbal tests that assess the strength of stroke patients’ short-term memory—specifically, their ability to hold and compare multiple words in their heads. It’s a factor that Martin’s research has associated with the ability to successfully retrieve stored language and maintain words in their mind as they participate in conversations. Diagnostic tests contained in the TALSA, for example, have patients listen to a series of words and try to repeat them back in order. Or, participants listen to three words, such as prison, jail and cage, and decide which two are most similar to each other, which requires keeping three different word pairings in working memory at the same time.
“In conversations, you hold in your mind what you want to say next. For people with mild aphasia, this is the main problem they have in a conversation. While another person is speaking, they have to hold on to words or phrases they will use, and they can falter over that added memory load,” Martin says.
The TALSA battery uses some tasks that are similar to those used in standard aphasia tests, but add memory load to these tasks. For example, established aphasia assessments might ask a patient whether two words, like hose and pose, rhyme.
“In our version, we add an interval between the first word and the second word, so we force the person to hold onto the one word, pose, wait five seconds, and then hose,” Martin says. “Now, do they rhyme or not? That's one way of adding memory load to the task, and that makes it harder to do for some people.”
Martin’s team has been refining and streamlining the verbal brain-teasers contained in TALSA for more widespread usage and building an easy-to-administer digital version of it.
“It’ll be web-based, administered on a tablet or computer screen,” says Wendy Greenspan, the research speech language pathologist managing the project. “In the field of adult speech pathology, as far as I can tell, there are no other tests that are digital. They’re all paper and pencil.”
Three hospitals and two university clinics will help beta test the TALSA software starting in 2020. The researchers hope the test eventually will be published and distributed along with established assessments for aphasia, potentially becoming a standard tool in the speech pathologist’s assessment toolkit.
“The traditional tests are more like a blunt instrument, where the TALSA is a very fine instrument that gets at the subtle differences of the different types of aphasia,” Greenspan says. “That means the therapist can have a much more targeted therapy approach—and make better use of the time that the insurance companies give for therapy.”