Which words contribute most to the functional communication of people with post- stroke aphasia?

Abstract

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Background Functional vocabulary selection is a key component of post-stroke language rehabilitation, yet limited evidence exists regarding which words are perceived as most meaningful by people with aphasia themselves. This study examined which vocabulary items are prioritised by individuals with aphasia or their relatives, as well as by chronic aphasia patients enrolled in the DULCINEA clinical trial.

Methods and Procedures This cross-sectional observational study comprised two phases. In Phase 1, 15 individuals previously affected by aphasia and their relatives completed an online survey designed to identify everyday words and short phrases considered essential for functional communication. After refinement and categorisation, a base list of 183 items was generated. In Phase 2, 20 participants with chronic post-stroke aphasia selected, with support from relatives and speech and language therapists, the words they wished totrain during the DULCINEA intervention. A total of 891 trained words were analysed. The analyses were conducted at two levels and on an exploratory basis. At the word level, generalized linear mixed models (GLMMs) with a negative binomial distribution were used to examine differences across semantic categories and selected subgroups (sex, age, and depressive symptoms). At the participant level, individual proportional distributions were compared between subgroups using Mann – Whitney U tests with false discovery rate (FDR) correction.

Results Conversation was the most frequently selected category in both the baseline list and the training items, followed by Series, Foods and Drinks, Emotional and Physical States, and Verbs. Descriptive variations were observed in certain categories according to sex and, to a lesser extent, age. No differences were observed according to the status of depressive symptoms. However, these subgroup differences were not statistically significant after correction for multiple comparisons and were associated with small effect sizes.

Conclusions Individuals with aphasia prioritise highly functional vocabulary relevant to everyday communication, particularly conversational terms. While exploratory variations were observed across subgroups, these findings should be interpreted with caution given their lack of statistical significance, the small sample size, and the exploratory nature of the analyses. Larger studies are needed to confirm these preliminary observations and to further inform patient-centered vocabulary selection approaches in aphasia rehabilitation.