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Impact of design factors on reading behaviours of people with aphasia: An eye-tracking study

Carlee Wilson1, Guillermina Noel2, H. Isabel Hubbard1 and Esther S. Kim1*
  • 1 University of Alberta, Communication Sciences and Disorders, Canada
  • 2 University of Alberta, Faculty of Medicine and Dentistry, Canada

Background: Aphasia is an acquired language impairment, characterized by difficulty with speaking, understanding, writing, and reading. Most people with aphasia (PWA) experience some degree of reading impairment (Brookshire, Wilson, Nadeau, Gonzalez Rothi & Kendall, 2014), ranging from mild reading comprehension difficulties to severe impairments in decoding and comprehending written text (Dietz, Knollman-Porter, Hux, Toth & Brown, 2014; Parr, 1995; Parr, 1996). Persistent reading disabilities can result in reduced social and occupational functioning and reduced psychological wellbeing (Cruice, Worrall, Hickson & Murison, 2003). Although aphasia friendly recommendations for text exist, they are often not based on empirical evidence, and do not consider principles of visual communication design (Rose, Worrall & McKenna, 2003; Brennan, Worrall & McKenna, 2005). For example, recommendations to increase the size and spacing of text, without considering the font can be insufficient (Kunz, 2000; Spiekermann & Ginger, 2002). The purpose of this study was to examine the impact of design factors (specifically, font and image presentation) on reading behaviours of PWA and healthy control participants. Method: Participants. Three PWA, one with Broca’s aphasia and two with Anomic aphasia, (mean WAB AQ=81.1, SD=8.1) and three demographically (age and education) matched controls participated in this study. Mean age of all participants was 64.2 years (SD=3.3, range = 61-69), and mean years of education was 12.7 (SD=2.5, range = 9-16). Procedures. All participants read four short paragraphs on a computer screen presented in two fonts (Calibri, Cambria) and two presentation types (text alone, text and image). Paragraphs were matched for difficulty and reading grade level, with an average length of 160 words and Flesch-Kincaid reading grade level of 5.5. Each paragraph was followed by 2 comprehension questions and participants were asked to fixate on the part of the passage that answered the question. An SR Research Eyelink 1000 with desk mounted camera and chin rest was used to collect eye movement data. Dependent measures per paragraph included: trial dwell time (sum of all fixation durations), fixation count, trial reading time (s), time to answer comprehension questions (s), and question response accuracy (% correct). Results: Independent samples t-tests revealed no significant differences for design factors (font, presentation), but group differences on all dependent measures except question response accuracy: trial dwell time (t(22)=-2.532,p=0.027), fixation count (t(22)=-2.733,p=0.019), trial reading time (t(22)=-2.758,p=0.018), time to answer questions (t(22)=-10.363,p=0.000), question response accuracy (t(22)=1.701,p=0.111). Discussion: Preliminary results from this study suggest when reading paragraphs on a computer screen, PWA fixate longer and make more fixations on words overall, take longer to read and take longer to answer questions relative to controls. Notably, their comprehension of what they read was not different from controls; design factors (font, image presentation) do not appear to impact reading behaviors of adults with and without aphasia. Data collection with additional participants is currently underway. Results from this study could potentially provide information that will guide the development of empirically-based recommendations for the creation of print materials for PWA.

Acknowledgements

This project was supported by the Killam Research Fund through the University of Alberta. The authors gratefully acknowledge Saul Sych for his contributions to this study.

References

Brennan, A., Worrall, L., & McKenna, K. (2010). The relationship between specific features of aphasia-friendly written material and comprehension of written material for people with aphasia: An exploratory study. Aphasiology, 19 (8), 693-711.

Brookshire, C.E., Wilson, J.P., Nadeau, S.E., Gonzalez Rothi, L.J., & Kendall, D.L. (2014). Frequency, nature, and predictors of alexia in a convenience sample of individuals with chronic aphasia. Aphasiology, 28(12), 1464-80.

Cruice, M., Worrall, L., Hickson, L., & Murison, R. (2003). Finding a focus for quality of life with aphasia: Social and emotional health, and psychological well-being. Aphasiology, 17(4),333-53.

Dietz, A., Knollman-Porter, K., Hux, K., Toth, K., & Brown, B. (2014). Supported reading comprehension for people with aphasia: Visual and linguistic supports. Journal of Medical Speech-Language Pathology, 21(4), 319-331.

Kunz, W. (2000). Typography: macro- and microaesthetics (3rd ed). Switzerland: Verlag Niggli AG.

Parr, S. (1995). Everyday reading and writing in aphasia: Role change and the influence of pre-morbid literacy practice. Aphasiology, 9(3),223-38.

Parr, S. (1996). Everyday literacy in aphasia: Radical approaches to functional assessment and therapy. Aphasiology, 10(5),469-79.

Rose, T., Worrall, L. & McKenna, K. (2003) The effectiveness of aphasia friendly principles for printed health education materials for people with aphasia following stroke. Aphasiology, 17 (10), 947-963.

Spiekermann, E., & Ginger, E.M. (2002). Stop Stealing Sheep & Find Out How Type Works. Tinker MA. Legibility of print. Iowa State Press.

Keywords: Aphasia, reading, Acquired alexia, Eye-tracking, Visual communication design

Conference: Academy of Aphasia 56th Annual Meeting, Montreal, Canada, 21 Oct - 23 Oct, 2018.

Presentation Type: poster presentation

Topic: Eligible for a student award

Citation: Wilson C, Noel G, Hubbard H and Kim ES (2019). Impact of design factors on reading behaviours of people with aphasia: An eye-tracking study. Conference Abstract: Academy of Aphasia 56th Annual Meeting. doi: 10.3389/conf.fnhum.2018.228.00060

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Received: 30 Apr 2018; Published Online: 22 Jan 2019.

* Correspondence: Prof. Esther S Kim, University of Alberta, Communication Sciences and Disorders, Edmonton, Alberta, T6G 2G4, Canada, esther.kim@ualberta.ca