Episode 136: Treating Discourse with Jessica Obermeyer

Interviewer info

Lyssa Rome is a speech-language pathologist in the San Francisco Bay Area. She is on staff at the Aphasia Center of California, where she facilitates groups for people with aphasia and their care partners. She owns an LPAA-focused private practice and specializes in working with people with neurogenic communication disorders. She has worked in acute hospital, skilled nursing, and continuum of care settings. Prior to becoming an SLP, Lyssa was a public radio journalist, editor, and podcast producer. In this episode, Lyssa Rome interviews Jessica Obermeyer about group treatment for aphasia.

Guest info

Jessica Obermeyer, PhD, CCC-SLP, is an Assistant Professor in the Department of Communication Sciences and Disorders at the University of North Carolina at Greensboro. Her area of specialization is acquired adult neurogenic language disorders. Dr. Obermeyer's research interests include discourse production in aphasia, treatment efficacy, and the cognitive requirements of language production. Prior to earning her doctorate, she worked in a variety of clinical settings where she specialized in assessment and treatment of adult neurogenic populations.

Listener Take-aways In today's episode you will: ● Recognize the role of written communication in clients' daily activities, including texting, email, and online tasks. ● Adapt ARCS-W treatment components to match each client's preferred writing modality (handwriting vs. typing). ● Identify candidates with aphasia who are well-suited for discourse-level writing treatment.

Lyssa Rome Welcome to the Aphasia Access Aphasia Conversations Podcast. I'm Lyssa Rome. I'm a speech language pathologist on staff at the Aphasia Center of California, and I see clients with aphasia and other neurogenic communication disorders in my LPAA-focused private practice. I'm also a member of the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources.

I'm today's host for an episode that will feature Dr. Jessica Obermeyer, who was selected as a 2024 Tavistock Trust for Aphasia, Distinguished Scholar, USA and Canada. Dr. Obermeyer is an assistant professor in the Department of Communication Sciences and Disorders at the University of North Carolina at Greensboro. Her area of specialization is acquired adult neurogenic language disorders. Dr Obermeyer's research interests include discourse production and aphasia treatment efficacy and the cognitive requirements of language production. Prior to earning her doctorate, she worked in a variety of clinical settings, where she specialized in assessment and treatment of adult neurogenic populations. Jessica Obermeyer, welcome to the podcast, and thanks for being here.

Jessica Obermeyer Thank you. It's a pleasure.

Lyssa Rome So I wanted to get started with a question we often ask, which is: How did you get into this? Was there an aha moment for you and what led you to research aphasia?

Jessica Obermeyer That's a great question. I think it was more of a slow awakening and journey to realizing that this is how I wanted to spend my days. When I started studying speech language pathology, I knew I wanted to work in adult rehab with people with traumatic brain injury, stroke, and aphasia. But as an undergraduate and a masters student, I worked on a lot of research related to traumatic brain injury and cognition. But then I had some exposure to aphasia research, and as a clinician, I just loved working with people that had aphasia. I loved running aphasia groups. I started aphasia groups, and when I decided to go back for my PhD, that is what I wanted to focus on. I also had the opportunity to work in adult outpatient, so I got to see a lot of people that had aphasia and were at different points in their rehabilitation journey. And those experiences just made me want to continue and especially do research that could develop and evaluate different treatment approaches for people that had aphasia.

Lyssa Rome One of the sort of through lines in your research has been discourse. And I'm curious about how you landed on that as the focus of your work, why discourse? Jessica Obermeyer It's how we talk. It was always, you know, something I was interested in. I think, as a clinician, I felt really daunted by discourse, because it is laborious, you know, it takes a lot of time to think about how you're going to analyze it. But I was always so fascinated by all the linguistic components that make up discourse as a clinician. And then I think as a researcher, I really appreciate how important it is. Everything we do in our day to day lives is often at a discourse level, and that looks so different depending on the type of discourse. So your text exchange is discourse, your emails, your conversations, the interaction with a barista. You know, every kind of functional way that we communicate is often at a discourse level. But it's so different depending on what that interaction looks like, and that's just endlessly fascinating to me as a researcher… challenging but fascinating.

Lyssa Rome Challenging both to evaluate and, I guess, to some extent, to treat. One of the things that I really appreciate is that it's how we communicate in our daily lives, and so if we're thinking about life participation and sort of functional approaches to treatment, to my mind, discourse is kind of where it's at. So I'm really excited to get to talk to you more about it. So speaking of discourse, I thought we could talk about your work on ARCS. Maybe we could start by telling us a little bit about the origins and how you became involved in researching.

Jessica Obermeyer Yes, I'd be happy to. I started doing research with ARCS as a doctoral student. So it's been a long time, but the origin of ARCS, or Attentive Reading with Constrained Summarization, started with Yvonne Rogalski and Lisa Edmonds, and they published the first paper, I think, in 2009, but someone should go back to check that, and it was originally for someone that had primary progressive aphasia. And then there was another paper published for two people with Wernicke's aphasia.

So in the original version, it's based on constrained summarization, and constrained only in that you're giving someone guidelines for how to summarize so they have to read through a segment of text. Usually it's a current event article, but clinically, you could use pretty much any written text. And I've actually done it with someone listening as well.

Typically with ARCS, you would have someone read a segment of written text and then summarize it with the constraint or guideline to be specific. So avoid words like it, stuff, thing, he, she. So use that really intentional word retrieval. That's not what we typically do. We often use non-specific words, but it's that therapeutic, like try to go for the really precise and specific word exercise that retrieval and to also stay on topic, so try not to add a tangent, or, you know, additional information that's not related to what you're reading. And then in my work, I've added an additional guideline that's just based on what that person needs. So if they're repeating a lot, then that might be part of the guideline. Often, the guideline is to try to include the essential information that you've identified already.

So that's the origin of ARCS. And as a doctoral student, I really wanted to do treatment research. I became really interested in cooperative learning theory, in how people can work together in their learning, collaborate to improve learning. And when I was doing that, reading and thinking about cooperative learning, writing seemed like such an excellent tool for that, because I think one of the hard things about spoken language is that it's just gone. You say it, it's gone. It's very hard to monitor, which I'm acutely aware of right now in this recording.

But with written text, you have this wonderful record of what you've produced, and that can be really helpful for thinking about language and planning, especially in an approach like ARCS or ARCS-W that emphasizes this planning, process-driven component, where you're thinking about, "What do I need to include in this discourse? What's important? What's not important? And what have I actually produced? Does that meet, you know, the guidelines I've tried to meet?" So that's how writing actually got pulled into it. And I wanted to keep the spoken language because, I don't know that I've ever met someone with aphasia who told me they didn't want to continue exercising their spoken language, but the writing was just I think, an important addition, because there are so few written discourse treatment options. And it allowed for this emphasis on monitoring and planning and some of the cognitive components of discourse that can be hard to address.

Lyssa Rome And maybe you could say a little bit about what you found when you've studied ARCS-W, so the Attentive Reading and Constrained Summarization-Written.

Jessica Obermeyer Well, people have improved, which is great. So the one of the things about ARCS and ARCS-W that's maybe unique when we think about aphasia treatment as a whole, is that it's not a treatment with trained items, so no items are repeated. You're working on the process of discourse production, this process of monitoring and trying to be specific, be efficient, you know. In written discourse, people have made improvements in correct information units or CIUs. So at the word level in discourse, the amount of informative and correct information that they're producing, people have made improvements at the utterance level, where they're producing more relevant utterances and more utterances that have a basic sentence structure, and then this hasn't been looked at in all of the studies, but for some of the participants, where we've measured things like main concepts, the amount that the person is conveying the main ideas or concepts in the discourse has improved for some people as well. And then at this spoken discourse.

So ARCS-W, it's half spoken, half written. Basically, people have also made similar improvements. So it's been encouraging so far, ARCS-W I would say, compared to ARCS is for people in the more mild aphasia end of the spectrum, especially with the writing component. Any clinician who's worked with people with aphasia will know that writing is often a stressful thing for people with aphasia. So it's for people that are writing at a phrase level already. It doesn't mean that their spelling is perfect, but if they're really struggling to get out a single word, this is probably not the ideal you know treatment for them, but for folks that are more on the mild end who want to work on spoken and written discourse, we have seen some positive results in their spoken and written discourse production.

Another thing that I think is really important for this treatment is that it is so multi-modality. When we write normally, we're reading as well. You know, we're not just writing in a vacuum. A lot of the time. We're rereading our text, we are reading that text message and then responding to it. So I like that. I like multi-modality treatments. I like that this is a treatment that allows people to address multiple types of language goals, while, you know, keeping it pretty simple and low tech. Lyssa Rome I think that that really hits on one of the reasons that I like using ARCS-W in my work with people is that It can be used with so many different kinds of texts. So I've used both, you know, work emails, if their goal is to get back to work, newspaper articles that interest them, simplified newspaper articles that interest there's so many possibilities. And anyway, it's exciting to hear you talk about that.

Jessica Obermeyer Yeah, I think that as a clinician, that's why I liked ARCS. It was so flexible, so easy to implement. And that's definitely one of the things I like about ARCS-W as well. Make treatment work hard for you.

Lyssa Rome So that is interesting to people as well. Where are you going next with your ARCS research?

Jessica Obermeyer Great question. I'm writing up results from about six people we ran over the last couple years, so that, I hope, gets submitted for publication soon. And I would really like to adapt this treatment a little further to use more assistive technology for folks that are really wanting to write, but aren't wedded to handwriting or typing in a traditional sense. So can we use speech-to-text? I always mix it up. And can we use methods to support people producing written language that are, you know, different than just typing it? Because people have really different needs in their life. So if that is a way to meet their writing needs, excellent, and I'd like to do that in the future.

Lyssa Rome I think that gets back to this idea that it's so flexible, right? You could adapt it in so many different ways. I think that that's really exciting, because it sort of further underscores the flexibility of this approach. And we were talking earlier, before we started recording, about using the same ARCS framework, or ARCS-W framework for material that clients have listened to, things like podcasts or TED Talks. So it seems like it's so adaptable, which is part of what I think makes it really exciting.

Jessica Obermeyer I think that's a great idea. We actually did use listening and then summarization for one of the participants in the first arc study, because that met their profile. That's how they wanted to interact with the treatment, and it worked out really well for them, and it's a great way to incorporate people's different interests. Not everyone wants to read, so being able to listen is a great option. And in the treatment for everybody, they always select their writing modality so they can either hand write or type, depending on what's relevant for them. In the population of people that have aphasia now, and I know that this will change over time, people have really different comfort levels with technology and with typing. So if someone says, "No, I never typed. I want to handwrite," then we can do that. And if, if it's the other, we can type. So I think listening is just another way to make it meet someone's needs better.

Lyssa Rome I was hoping that you could talk a little bit more about the similarities and differences between different types of discourse. So spoken and written discourse, typed and versus handwritten discourse. Tell us a little bit more about that. Jessica Obermeyer Yeah, of course. Well, I should, I guess, start off by saying, working on the ARCS-W treatment research, I recognized just how little information is out there on written discourse and the majority of discourse measures that we use in aphasiology are based on spoken discourse production. But there are differences in how we speak versus how we write. So in spoken language, we've already talked a little bit about this, it's temporal, it's just gone. So writing is tangible. You have a record of your writing, and that can be really beneficial for people with aphasia. But of course, there's there's other things that can make writing more challenging as well.

With spoken language, of course, we have the suprasegmental components of what we're saying. So we have our tone and our facial expression and things that allow us to impart meaning without actually saying it, and we don't have that in writing. Although things are shifting with text messaging technologies, we can add emojis and memes that help us communicate information. But I think when we're thinking about traditional writing, it doesn't have those additional components, and therefore people have to be more explicit with their word choice and a little more clear in what they're trying to say. People are often more efficient in writing. They use fewer words than they would in speaking. So those are some of the differences.

We can't automatically correct our written output because we see that our partner doesn't understand. Because in writing, there's this distance between when we're writing versus when we think someone's reading it. Even in more instant platforms like text messaging, we don't know exactly when someone's reading something or how their face looks when they read it, in the way we know with speaking. So those differences do impact how we complete the task. And of course, the context of writing changes it dramatically. So you write notes to yourself really differently than you write a research paper or a work email. And that's not so different from speaking, right? The context is still going to impact how we speak or write, very much.

So in my work, I've looked at how writing and typing are the same or different. And this is a pretty new area. There's a couple papers out there on it now, and I think it's gaining traction, which is great, because most people write through typing in their daily life now. What I found is that at a group level, it's pretty similar. Writing and typing look pretty similar for people that have aphasia. But individually it can be very different. So an individual person with aphasia might have a strength or weakness in handwriting versus typing for lots of different possible reasons, like their experience, or hemiparesis, their desire to do one or the other. But it's not, the patterns aren't completely clear. I think clinicians are probably really used to hearing that every individual with aphasia has the potential to be different. So I think that keeps with written and typed language output, handwritten and typed.

Some of my recent work has been related to looking at different writing modalities for people with aphasia. So are there differences in their handwritten versus typed discourse production. There's a couple papers out on this now, and hopefully there'll be even more as it gains traction. And I think it's getting more attention in the research literature because of how important writing is in our daily lives now. I mean, most activities of daily living are now completed through, you know, the virtual world, so banking, shopping, lots of messaging are completed through reading and writing now. So that's kind of why I became interested in also working with ARCS-W and having people handwrite versus type, depending on their interest and comfort level. It was always interesting to me why certain people picked one or the other, and kind of what I was seeing. There is some research out there that shows that handwriting is advantageous for learning. So the specificity of how we're moving our fingers to create letters is helpful for retention and learning items, but when we're thinking at the discourse level, when we're not using the same items necessarily, things could potentially be a little different. So I was interested in just exploring some of those differences and patterns that might emerge, and if there was anything I could figure out that might be driving a pattern. So if someone's better at typing than handwriting, is there a reason that they're better? So what I have found so far, and it's it's pretty preliminary, is that at the group level, handwriting and typing look very similar for people with aphasia, so oftentimes, there's not a big difference in the total words that they produce, and that's been confirmed by a larger study as well from Jaime Lee and colleagues. But then when we look at the individual level, that's when you can start to see differences. And I don't think any clinician would be surprised to hear that people with Aphasia are variable or different. So we know that that is common, but it's been pr