State of the Field: Spoken Discourse in Aphasia

Barrier 1: Fragmentation in Use of Discourse and Absence of Standards

Spoken discourse is increasingly recognized as essential in the assessment and treatment of aphasia. Unlike isolated tasks such as naming or repetition, discourse provides both microstructural (syntax, lexical-semantics) and macrostructural (cohesion, coherence) insights into communication. However, across studies, procedures for eliciting, measuring, and analyzing discourse are inconsistent. This has created a fractured evidence base and hindered cumulative progress. 

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When this group was created in 2019, no unified reporting standards existed for discourse studies in aphasia. Some studies report only inter-rater reliability; others omit critical methodological details; statistical approaches vary widely. This lack of transparency impeded replication and weakens the impact of findings. Other fields have addressed this challenge through initiatives like COBIDAS, CONSORT, and EQUATOR, which specify the minimal information necessary for reproducible and trustworthy research.

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Our Response: Experts across the field have called for a systematic approach, culminating in the establishment of a more standardized approach to discourse assessment and analysis. 

• Stark, B. C., Bryant, L., Themistocleous, C., Den Ouden, D. B., & Roberts, A. C. (2023). Best practice guidelines for reporting spoken discourse in aphasia and neurogenic communication disorders. Aphasiology, 37(5), 761-784.

 

Barrier 2: Limited Psychometric Evidence

Over 536 unique discourse outcomes have been reported in the literature (Bryant et al., 2016). This heterogeneity makes meta-analysis nearly impossible and leaves clinicians and researchers without clarity on which measures are stable, valid, or reliable. Even widely used indices such as words per minute or Correct Information Units lack sufficient psychometric grounding, and little is known about intra-subject variability at test-retest (Pritchard et al., 2018).

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Our Response: Recent work has begun filling this gap, providing test–retest and reliability data on select outcomes. These benchmarks will enable researchers and clinicians alike to distinguish true treatment effects from background variability.

• Stark, B. C., Alexander, J. M., Hittson, A., Doub, A., Igleheart, M., Streander, T., & Jewell, E. (2023). Test–retest reliability of microlinguistic information derived from spoken discourse in persons with chronic aphasia. Journal of Speech, Language, and Hearing Research, 66(7), 2316-2345.

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Barrier 3: The Research–Clinic Divide

Even as discourse analysis gains traction in research, translation into everyday clinical practice has been slow. Clinicians cite multiple barriers: outdated or irrelevant stimuli, lack of time-efficient tools, limited training in discourse scoring, and uncertainty about clinical utility. Patients, meanwhile, report that current language assessments often feel disconnected from the real-world communication challenges they face. This disconnect risks leaving discourse sidelined in clinical decision-making, despite its central role in functional communication.

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Our Response: By embedding discourse tasks that are ecologically valid, clinically feasible, and directly tied to treatment planning, we are accelerating the adoption of discourse analysis in practice. These efforts ensure that research advances translate into tangible benefits for patients and clinicians alike.

• Stark, B. C., Dutta, M., Murray, L. L., Fromm, D., Bryant, L., Harmon, T. G., ... & Roberts, A. C. (2021). Spoken discourse assessment and analysis in aphasia: An international survey of current practices. Journal of Speech, Language, and Hearing Research, 64(11), 4366-4389.

• Stark, B. C., & Dalton, S. G. (2024). A scoping review of transcription‐less practices for analysis of aphasic discourse and implications for future research. International Journal of Language & Communication Disorders, 59(5), 1734-1762.

• Dutta, M., Murray, L. L., Park, H., Burklow, E., Bose, A., Kim, H., ... & Casilio, M. (2025). Let's Chat About Spoken Discourse: A Tutorial to Support Use of Spoken Discourse Analysis When Providing Aphasia Clinical Services. American Journal of Speech-Language Pathology, 1-36.

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Looking Forward

The field is at a turning point. Through coordinated community efforts, discourse research is moving toward a systematic, rigorous, and clinically impactful future. This transformation will not only strengthen the scientific base but also ensure that persons with aphasia's most valued communicative goals (Worrall, 2011) are placed at the center of assessment and intervention.