MCT sensitive to mild deficits (Bunker et al., 2025)

Purpose: The Western Aphasia Battery–Revised (WAB-R) is often used for diagnosis of aphasia. However, persons scoring above the WAB-R diagnostic cutoff may still present with language difficulties indicative of aphasia. Identification of residual language challenges is critical for treatment referral or inclusion in research. We examined differences in discourse following acute left-hemisphere stroke for those above/below the WAB-R diagnostic cutoff compared to healthy controls, as well as recovery during the first year.
Method: Sixty-eight participants with acute left-hemisphere stroke completed the WAB-R and were classified as aphasic by WAB-R (ABW; n = 42) or not aphasic by WAB-R (NABW; n = 26). They completed the Modern Cookie Theft (MCT) picture description task at two time points: acute and either 3, 6, or 12 months poststroke. Responses were analyzed for content units, total verbal output, efficiency, and lateralization of content (i.e., right vs. left side of stimulus) and compared to 49 healthy controls. Differences between groups were examined using Wilcoxon rank-sum tests. Change over time was examined using robust linear mixed-effects regression.
Results: Wilcoxon tests showed differences between healthy controls and ABW or NABW on all MCT metrics except efficiency for those NABW. Regression models showed no main effects of group or interaction between group and time point.
Conclusions: The NABW group showed deficits in verbal output, content production, and laterality on the MCT picture description task, suggesting the presence of possible aphasia and hemispatial neglect. Measures derived from the MCT may be more sensitive to residual language/communication difficulties not captured by the WAB-R. The NABW group also showed similar patterns of recovery as the ABW group, highlighting the MCT task’s ability to capture change for those with mild impairments. Results support use of the MCT task in clinical settings, particularly if/when mild deficits are probable/suspected.
Supplemental Material S1. Wilcoxon rank-sum test results for healthy controls vs. participants with stroke.
Bunker, L. D., Berube, S. K., Neal, V., Kelly, L., Kelly, C., Meier, E. L., Hillis, A. E. (2025). Discourse measures from the modern cookie theft picture description are sensitive to mild communication deficits not captured by the Western Aphasia Battery–Revised Aphasia Quotient. American Journal of Speech-Language Pathology, 34(3), 1100–1120. https://doi.org/10.1044/2024_AJSLP-24-00322

研究目的：西部失语症检查表修订版（Western Aphasia Battery–Revised, WAB-R）是失语症诊断的常用工具。然而，部分得分高于WAB-R诊断分界值的受试者仍可能存在符合失语症表现的语言障碍。识别残留语言障碍对于转诊治疗或纳入研究至关重要。本研究对比了急性左侧脑卒中后、WAB-R诊断分界值上下两组受试者与健康对照的话语特征差异，并分析了卒中后第一年的语言恢复情况。

研究方法：本研究共纳入68名急性左侧脑卒中受试者，所有受试者均完成WAB-R评估，并根据结果被分为失语组（ABW组，n=42）与非失语组（NABW组，n=26）。受试者分别在卒中急性期、卒中后3/6/12个月中的一个时间点完成两次现代偷饼干任务（Modern Cookie Theft, MCT）图片描述测试。研究者对受试者的语言应答进行多维度分析，包括内容单元数、总语言输出量、表达效率以及内容偏侧化（即刺激图左右侧的描述偏好），并与49名健康对照进行比较。组间差异采用威尔科克森秩和检验进行分析，随时间的变化趋势则采用稳健线性混合效应回归进行检验。

研究结果：威尔科克森检验显示，健康对照组与ABW组、NABW组在MCT的所有指标上均存在显著差异，仅NABW组的表达效率除外。回归模型分析未发现组别主效应，亦未发现组别与时间点的交互效应。

研究结论：NABW组在MCT图片描述任务中的语言输出量、内容生成量及偏侧化表现均存在缺陷，提示该组可能存在失语症及半侧空间忽视。MCT衍生的评估指标对WAB-R未检出的残留语言/沟通障碍具有更高的敏感性。NABW组的恢复模式与ABW组相似，进一步证明MCT任务能够捕捉轻度损伤受试者的语言变化。本研究结果支持MCT任务在临床场景中的应用，尤其是在疑似或存在轻度语言缺损的情况下。

补充材料S1：健康对照组与脑卒中受试者的威尔科克森秩和检验结果。

参考文献：Bunker, L. D.、Berube, S. K.、Neal, V.、Kelly, L.、Kelly, C.、Meier, E. L.、Hillis, A. E.（2025）。《现代偷饼干图片描述任务的话语指标可检出西部失语症检查表修订版失语商数未识别的轻度沟通障碍》。《美国言语语言病理学期刊》，34(3)，1100–1120。https://doi.org/10.1044/2024_AJSLP-24-00322