Towards an integrated narrative analysis in nonfluent aphasia

Background: Narrative discourse offers a rich source of information about linguistic ‎abilities, capturing micro-linguistic (word and sentence level) and macro-linguistic ‎‎(story structure) features. While prior studies often focus on isolated aspects, this ‎study adopts a comprehensive approach to analyze multiple narrative variables ‎simultaneously.‎ Aims: To examine 27 linguistic measures at the word, sentence, and narrative levels in ‎order to determine which variables differentiate people with aphasia (PWA) from ‎neurotypical (NT) speakers and to explore potential trade-offs or compensatory ‎patterns in narrative production.‎ Methods & Procedures: Narratives were elicited from 10 participants with nonfluent ‎aphasia, assessed via the Western Aphasia Battery or the Boston Diagnostic Aphasia ‎Examination, and 46 neurotypical controls. Participants narrated a recent vacation. ‎Narratives were recorded, transcribed, and analyzed across 27 measures related to ‎lexical, syntactic, and discourse dimensions, as well as output quantity, efficiency, ‎fluency, and coherence.‎ Outcomes & Results: Fourteen of the 27 variables did not differentiate the groups; ‎however, 13 variables showed significant differences. At the word level, PWA used a ‎higher proportion of nouns and demonstrated greater lexical diversity. At the sentence ‎level, they produced fewer grammatical and complex sentences. At the narrative level, ‎PWA included fewer evaluative clauses. They also produced fewer sentences, ‎communication units, and words per sentence. Efficiency and fluency measures ‎indicated a lower proportion of correct verbal units and increased false starts and ‎fillers. Coherence analysis revealed that PWA produced fewer meaningful sentences. ‎Trade-off strategies were observed, such as a preference for simpler yet accurate ‎sentences or more complex sentences with increased errors.‎ Conclusions: This comprehensive analysis highlights the need to examine multiple narrative ‎dimensions in tandem to better understand the linguistic capabilities of individuals with ‎aphasia. The identification of compensatory strategies provides insight into individual ‎differences in narrative production and can inform assessment and intervention ‎practices.‎.