German Language Adaptation of the NAVS (NAVS-G) and of the NAT (NAT-G): Testing Grammar in Aphasia

Ruth Ditges, Elena Barbieri, Cynthia K Thompson, Sandra Weintraub, Cornelius Weiller, Marek-Marsel Mesulam, Dorothee Kümmerer, Nils Schröter, Mariacristina Musso, Ruth Ditges, Elena Barbieri, Cynthia K Thompson, Sandra Weintraub, Cornelius Weiller, Marek-Marsel Mesulam, Dorothee Kümmerer, Nils Schröter, Mariacristina Musso

Abstract

Grammar provides the framework for understanding and producing language. In aphasia, an acquired language disorder, grammatical deficits are diversified and widespread. However, the few assessments for testing grammar in the German language do not consider current linguistic, psycholinguistic, and functional imaging data, which have been shown to be crucial for effective treatment. This study developed German language versions of the Northwestern Assessment of Verbs and Sentences (NAVS-G) and the Northwestern Anagram Test (NAT-G) to examine comprehension and production of verbs, controlling for the number and optionality of verb arguments, and sentences with increasing syntactic complexity. The NAVS-G and NAT-G were tested in 27 healthy participants, 15 right hemispheric stroke patients without aphasia, and 15 stroke patients with mild to residual aphasia. Participants without aphasia showed near-perfect performance, with the exception of (object) relative sentences, where accuracy was associated with educational level. In each patient with aphasia, deficits in more than one subtest were observed. The within and between population-groups logistic mixed regression analyses identified significant impairments in processing syntactic complexity at the verb and sentence levels. These findings indicate that the NAVS-G and NAT-G have potential for testing grammatical competence in (German) stroke patients.

Keywords: aphasia; aphasia’s therapy; syntactic competence.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Overlap of the binarized stroke lesions in the left hemisphere (LH) and right hemisphere (RH) in patients with aphasia and without aphasia respectively. The color bar indicates the degree of overlap of lesions: the darker the color, the fewer the patients with a lesion in this area.
Figure 2
Figure 2
NAVS-G VNT results: The bar charts display the results in the healthy participants (HP), the right hemispheric stroke patients (RHSP) without aphasia, and the left hemispheric stroke patients (LHSP) with aphasia for verb naming with one argument (ob1), optional two and three arguments (op2/3), and obligatory two and three arguments (ob2/3). Participants without aphasia show a ceiling effect across verb-types. LHSP patients display worse performance for ob 2/3 versus op 2/3 verbs and, in obligatory with more than one argument (* p < 0.05, ** p < 0.005).
Figure 3
Figure 3
NAVS-G SPPT result: The bar charts display results in the healthy participants (HP), the right hemispheric stroke patients (RHSP) without aphasia, and the left hemispheric stroke patients (LHSP) with aphasia for production of several types of sentences: A = active, P = passive, SWQ = subject Wh-question; OWQ: object Wh-questions; SR = subject relative; OR = object relative. Full color bars indicate canonical sentences, and crackled color bars indicate non-canonical sentences. In HP and LHSP groups, non-canonical sentences (nC) are performed more poorly than canonical (C) sentences, but in LHSP the effect remained significant after excluding relative sentences. In all three groups, relative (Rel) accuracy is worse than non-relative (nonRel) sentences and OR shows the worst accuracy; OR sentences show the worst accuracy in the LHSP group. In these patients, accuracy decreases with increase of syntactic complexity also within canonical sentences. * p < 0.05, ** p < 0.005.
Figure 4
Figure 4
Predictive factors for NAVS-G SPPT accuracy. (A): Results of the analysis group*sentence type*education relative to OR-SPTT (in y axis: leaving school certificates according to the German school system, see Table 1). HP and right hemispheric (RH) stroke patients with no leaving certificate performed worse than participants with Abitur (secondary high school) (see Table 6, p < 0.001 and = 0.003, respectively R2 = 0.947). (B): Results of the analysis group*sentence type*age: The older the HP and the RH patients (not the patient with aphasia), the worse the performance (p = 0.003 and = 0.043, respectively R2 = 0.655). (C): In patients with aphasia, it is functional communication, as reflected by the scores of the AAT spontaneous speech (p < 0.001, R2 = 0.18), which negatively relates to SPPT performance. The more difficulties in communication the patients had, the more difficulty they had in performing the SPPT.

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