rethinking patient provider care through visual communication · that exist in a larger image...

https://doi.org/10.1177/1470357220915605

Visual Communication 2020Vol. 0(0) 1–17

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DOI 10.1177/1470357220915605

v i s u a l c o m m u n i c a t i o n

Rethinking patient–provider care through visual communication

S T A C y E l k OTexas Tech University, lubbock, USA

J O h n A V E l E zIndiana University, Bloomington, USA

M E l I n D A C O R w I nTexas Tech University health Sciences Center, lubbock, USA

J U S T I n R O B E R T k E E n ETexas Tech University, lubbock, USA

A B S T R A C T

The case study presented in this article developed an improved interven-tion for visually communicating with persons diagnosed with a communica-tion disorder known as aphasia. The Visual Interactive Narrative Intervention (VINI) assists health-care providers in educating post-stroke persons with aphasia (PWA) about their stroke, symptoms, rehabilitation options, and quality of life issues. Visual communication is under-utilized to convey health information to PWA despite its ability to capitalize on their intact cognitive and visual processing. The current Reflections on Practice summarizes visual guidelines from previous research, discusses visual design principles to achieve these guidelines, and presents a case study of creating visual stimuli for PWA based on these considerations and initial pilot testing with PWA. The case study demonstrates the creative process, the visual design considerations, and the interdisciplinary effort (i.e. health professionals, art-ists, and communication scholars) necessary for visually communicating with PWA.

k E y w O R D S

activity of daily living • aphasia • creative art therapy • depression • experiential visualization • quality of life • visual communication • visual language • visual vocabulary stroke

915605 VCJ Visual CommunicationElko et al.: Rethinking patient–provider care through visual communication

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The communication difficulties of persons with aphasia (PWA), a communica-tion disorder, are a crucial problem for the estimated two million people who have this condition. Aphasia immediately complicates communication with health-care providers, family members, friends, and co-workers by impair-ing a person’s ability to produce and comprehend verbal and written com-munication (McGilton et al., 2012). PWA have damaged speech, language, and comprehension centers of the brain (left hemisphere) commonly due to a stroke or a traumatic brain injury and, as a result, face additional health risks associated with inefficient and ineffective communication with health-care providers (i.e. patient–provider communication). Poor patient–provider communication has been connected with premature mortality and reduced productivity of stroke survivors that account for $23.6 billion of indirect costs in the United States (Demaerschalk et al., 2010). It is estimated that half of adverse hospital problems could be prevented with better patient–provider communication which is particularly lacking for older populations and those with communication disorders, such as aphasia, who also tend to be above 51 years of age (Bartlett et al., 2008; Eslinger and Damasio, 1981).

After being diagnosed with aphasia, PWA become part of a multidisci-plinary treatment team, including physical, occupational and speech-language therapists who utilize a variety of traditional therapeutic interventions dur-ing recovery. However, many of these health professionals primarily rely on written and verbal language to (a) educate PWA about their condition and treatment goals and (b) administer their treatment and therapy. Given the communication complexities of aphasia, there is a need to circumvent dam-aged language centers of the brain using a different form of communication protocol. The visual cortex or right hemisphere houses the person’s ability to understand visual information (Brown and Thiessen, 2018). Therefore, pic-tures are commonly used by speech and language therapists to supplement communication of basic information, converse with PWA, and administer speech therapy. For example, many digital therapeutic tools used by health professionals and PWA to rebuild vocabulary includes practicing picture–word associations (e.g. Tactus, Lingraphica and Constant Therapy).

Despite some health-care providers incorporating visual communi-cation into PWA therapy and rehabilitation efforts, PWA are still left con-fused and puzzled about many aspects of their medical care. One such pivotal aspect is PWA diagnostic and prognostic health information. Indeed, health professionals lack resources and tools to help PWAs understand their con-dition and treatment plans before they even begin therapy with the word-association applications mentioned above (Simmons-Mackie, 2018). Many PWA become discouraged and disengaged during therapy because they lack a clear grasp of their condition, treatment plan, and the goals and milestones they should strive for and look forward to. That is, many PWA lack a clear vision of their rehabilitation progress to keep them motivated and engaged in

3E l k o e t a l . : R e t h i n k i n g p a t i e n t – p r o v i d e r c a r e t h r o u g h v i s u a l c o m m u n i c a t i o n

therapy, which often leads to quality of life issues. Furthermore, aphasia does not affect intelligence, which suggests patients are capable of facilitating their own rehabilitation given their full engagement and participation in therapeu-tic efforts (Morris et al., 2015). However, in order to capitalize on the ability of PWA to fully cooperate and assist with their own treatment plan, they must first comprehend their current condition and the treatments specialists have designed for them.

In order to visually communicate with PWA, one must simultane-ously take into account previous research, multiple design principles, and the particular limitations aphasia can have on visual processing. The cur-rent article provides an example of the necessary steps for creating visual stimuli for PWA by presenting a case study of an intervention designed to visually communicate diagnostic and prognostic health information. First, guidelines from previous research are summarized and the visual design principles health professionals can utilize to achieve these guidelines are discussed.

V I S U A l C O M M U n I C A T I O n A n D A p h A S I A

Previous research has examined how aphasia can influence PWA’s process-ing of visual information. Table 1 presents seven recommendations synthe-sized from research that examined the effectiveness of certain visual aspects for fostering comprehension in PWAs while also factoring for specific limi-tations presented by aphasia. The art, color and visual design considerations targeted clear, uncluttered expression of the information that solidified abstract ideas with concrete images, and contextualized them among com-plementary information.

Health professionals and artists can rely on the following design prin-ciples and theories to create visuals that align with the above recommenda-tions, and therefore be understood holistically by PWA. Specifically, profes-sionals should use compositional and two-dimensional design principles, juxtaposition of visual elements, points of emphasis, and repetition to create visually interesting images that maintain the attention of PWA and foster comprehension.

Composition is how the images and background are arranged to main-tain visual interest. Placing an object in the middle of the page may seem to be the logical place, but focusing on the middle can neglect the other parts of the overall image. In a task-based image (Brown and Thiessen, 2018) as used in the current article, the artist should create images and space relationships causing the viewer’s eyes to move about the scene. Thus asymmetrical balance, or visual balance that is off-center, is a better choice. If the point of emphasis is placed elsewhere on the page, the artist will often juxtapose or counter-balance the major point of focus, causing the viewer’s eyes to move around the scene.


This allows PWA to naturally process the complementary information relating to the point of emphasis. Counterbalancing the positive or active images (i.e. the subject) with the other active images or background will create more visu-ally interesting compositions. This juxtaposition or counterbalancing can be accomplished by using large, simple shapes, a collection of small shapes, active shapes, passive shapes, color, value, texture, patterns, and/or large and small directional movements (Lauer and Pentak, 2011). Contextually rich and con-sistent imagery will reinforce the message and create less confusion for PWA (Brown and Thiessen, 2018). For example, in creating the image (Figure 1), it is the intention of the artists that the viewer’s eyes move around the composi-tion but remain within the picture plane.

An overly centralized composition is visually static and may cause the viewer to become bored or for the eyes to wander off the picture plane. The red arrows are the most likely path that the viewer’s eyes will travel. The three figures are in an arc in the upper third of the composition with the central figure just offset from the center of the composition and the right figure the most visually animated. Eye direction is a compositional principle that states a viewer’s eyes will naturally follow the eyes of the figure or figure-like shapes that exist in a larger image (Lauer and Pentak, 2011). The therapist (1) is the most animated figure and thus is the major emphasis of the composition and where the viewer’s eyes will focus first. As she is looking right, the viewer’s eyes

Table 1. Recommendations for visual communication with PWA.

No. Recommendation Source/citation/resource

1. Create drawings that illustrate abstract ideas using a combination of concrete images in a contextually rich setting.

Brown and Thiessen (2018)

2. Use a variety of colors and compositions. PWA pay more attention to color images rather than simple line drawings.

Mckelvey et al. (2010)

3. Repeat imagery, such as using consistent styles, characters, and scenes in order to avoid confusion and reinforce information.

Wallace et al. (2012)

4. Keep narration simple, and pair with supporting images.

Wallace et al. (2012)

5. Use contextually rich drawings rather than staged photos, despite being quicker to create, use and test.

Duh et al. (2016); Snyder (2003).

6. Visuals cannot be overly stimulating due to the limited cognitive resources of PWA.

Magnusson et al. (2018)

7. Use a multimodal approach that incorporates language alongside images, gestures, interactions and relationships between them.

Holsanova (2012); Jewitt (2010).


will follow her gaze (2) to either the central figure or to the far figure, which they will recognize as the avatar that has been in every image from the begin-ning of the VINI. Their eyes will then most likely travel in a circle (3) around the three tablets and pencils set in an arc around a table (4).

The green arrows represent other compositional possibilities incorporated into the image. The avatar’s eyes look back left (5), which will then move the viewer’s eyes toward the central figure and then down (6), again sweeping around the table (7) back to the animated figure (1). These other shapes and lines within the composition reinforce the eye movement. The black chairs (8), set upon a very light colored floor also move the viewer’s eyes inward to the central focus which is the three fig-ures and the activity of therapy. The smaller shapes in the background and the perspective of the walls also direct the viewer’s eyes back inwards as they move about the scene.

We used four visual design principles (emphasis, repetition, unity with variety, and juxtaposition of shapes and colors) and the synthesized recom-mendations (see Table 1) to create an intervention aimed at visually commu-nicating PWA’s health information (i.e. diagnosis and prognosis). The follow-ing is a case study examining the decisions taken to create the intervention’s visual stimuli based on the above considerations and initial PWA feedback collected in a pilot study of the intervention’s visual design.

T h E V I S U A l I n T E R A C T I V E n A R R A T I V E I n T E R V E n T I O n ( V I n I )

The intervention was created with the specific goal of educating and engag-ing PWA with information about how their condition occurred, how their condition will affect their everyday lives, and what they can do to rehabilitate and return to their typical lives. Additionally, the intervention was also meant

figure 1. Showing point of emphasis and eye movement throughout the composed image. © Stephanie Berrie, Jeramiah Macha and Stacy Elko, 2017.


to foster hope that the obstacles and limitations presented by aphasia were surmountable and that one can still live a happy and fulfilling life with friends and family. This Visual Interactive Narrative Intervention (hereafter known as VINI) was designed to take PWA through a visual description of a main character’s narrative which included pre-stroke life, a stroke, the immediate and post-stroke symptoms, hospital stay, post-stroke recovery and future life-style changes. PWA are encouraged to take on the role of the main character by interacting with the narrative and choosing which activities the character engages in at different time points across the narrative.

By combining and connecting these various pieces of educational con-tent within a single timeline, experienced by PWA through the main charac-ter, the VINI is able to consolidate and simplify the relevant health informa-tion to a more accessible level for PWA. That is, PWA should obtain a better and holistic understanding of their own lives with aphasia by witnessing and participating in the changes of the character across the narrative. However, the health information is first and foremost represented visually to PWA, which serves as the foundation that the narrative and interactive components are built upon. Thus, various phases of visual stimuli design and testing occurred before the full intervention was able to be created.

V I S U A l p l A n n I n g , D E S I g n I n g , A n D C R E A T I O n

The first phase in the development was a paper prototype, a commonly used process that aids in creating interventions that meet the user’s expectations and needs. Paper prototypes are constructed rapidly, giving the creators and testers important results necessary for the iteration of an improved product (Snyder, 2003). The narrative structure of the paper prototype was developed to include all the relevant health information. Therefore, the visual stimuli were first created as storyboards that portrayed the character throughout the narrative (Figure 2).

During these 108 initial storyboards, attention was paid to quickly generating compositions for the narrative arch, picking the main point of emphasis that later drawings would be built around. For example, storyboards mainly consisted of the main character and one or two other objects in the image that would best indicate the context and meaning of the image for the character and, thus, for the PWA. It was ensured the main character was part of the focal points of emphasis in each image because, as recommended above (Wallace et al., 2012), repetition and familiarity with the character should help comprehension, and thereby foster identification with the character through-out the narrative.

Once the storyboard sketches were finalized, a second iteration of the compositions was expanded upon with finer details and colors. Although it was estimated that over 200 finished drawings would be needed, 77 sketches were chosen to be expanded upon. Specifically, graphic imagery with


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minimal drawing distractions, one-point perspective (the representation of the three-dimensional space on a flat picture plane), and flat, uncluttered color were incorporated following the above recommendations for the use of color (Mckelvey et al., 2010 ) and simplicity (Magnusson et al., 2018).

Finally, the backgrounds surrounding the points of emphasis were cre-ated to direct and focus PWA’s attention to aspects that conveyed the image’s meaning and place among the narrative. As recommended by previous research, providing contextualized images is important for PWA comprehension of visual communication (Brown and Thiessen, 2018). For example, depicting a brain against an empty background when attempting to convey how a stroke occurred within the PWA’s own brain may be confusing. The ability for the PWA to make connections between the brain and their own person was important. Therefore, the silhouette of the main character’s head along with some finer identifying facial features were placed around the brain as a visual cue of the image’s appli-cability to the main character and thus, the PWA (see Figure 3).

At the end of this first phase, there was a set of 77 prototype drawings that included points of emphasis surrounded by contextualized backgrounds and colors. These prototype drawings were based on the above recommenda-tions from previous research and design principles identified as useful in fol-lowing the guidelines. The project team then reviewed the images with expert guidance from the team’s speech pathologist. After making small adjustments for consistency and interpretability, the set of prototype drawings were ready for pilot testing among the population of interest (i.e. PWA).

p I l O T S T U D y

participants and designThe 77 prototype drawings were pilot tested twice. Participants were attend-ees of a two-week summer aphasia arts program focused on using music and art as part of the recovery and life participation process to enhance

figure 3. Image out of context; image in context. © Stephanie Berrie, Jeramiah Macha and Stacy Elko, 2017.


communication abilities after acquiring aphasia. A focus group of 10 partici-pants from the camp discussed the prototype drawings. Specifically, images were presented with an explanation of the image’s individual elements and the scene holistically. Feedback was solicited from the focus group regard-ing the images’ composition (e.g. colors, background elements, placement of objects, etc.) and the effectiveness of the image to depict individual elements and the overall scene. Additionally, an interview was conducted with one per-son with aphasia who was shown a video connecting the 77 images into a broad outline of the entire narrative. Feedback on the individual images and their ability to portray the timeline of the narrative was solicited.

ResultsFeedback from the pilot testing coalesced around two themes. The first theme consisted of improvements along the seven recommendations syn-thesized from previous research (see Table 1). For example, in the bedroom image of Figure 4, although the character may be sitting on the bed approxi-mately in the center of the picture, the second drawing, where the walls con-verge with the small items such as the lamp and window, draws the viewer’s eyes toward the character sitting on the bed, and is a more visually interest-ing, focused picture.

Also, the colors are more subdued in the second bedroom drawing with small areas of saturated colors. The initial sketch is exceedingly saturated with an overly high contrast and appears flat and uninteresting compared to the second. The kitchen images, beside the open window above the stove, had perspective issues and the dark refrigerator, contrasting with the white coun-tertop, was relatively uninteresting in comparison to a more contemporary kitchen arrangement. The last drawing of the office worker had the character communicating with a second person. The telephone and papers on the floor appeared more interesting than the static image of the person merely sitting at the computer. Additionally, attention to the realism seemed to be a concern with feedback that noted windows are not routinely found above stoves, beds are usually not sitting directly on the floor and workers often have a telephone in their hand and papers on the desk.

The second theme consisted of adding elements to images or even requests for entirely new images that increased comprehension of the nar-rative itself. This feedback either identified gaps in the narrative that caused confusion or suggested better visual cues that would more effectively indicate where the image is taking place within the narrative arc. For example, a close-up of the blood clot during the explanation of an occlusive stroke was sug-gested for clarity and comprehension (see Figure 5).

New images were suggested that showed the main character’s (i.e. the PWA) uncertainty to better reflect the uncertainty felt by stroke survivors and PWA in particular. It was suggested that images show the main character asking questions such as: ‘Am I going to have another stroke?’ or ‘Am I going to die?’


figure 5. Comparing a clogged pipe to the clogged artery of an occlusive stroke. © Stephanie Berrie, Jeramiah Macha and Stacy Elko, 2017.

figure 4. Markup and final drawings. © Stephanie Berrie, Jeramiah Macha and Stacy Elko, 2017.


D I S C U S S I O n

Using the feedback from the pilot study, approximately 200 final drawings were generated. These images were incorporated with the narrative and interactive features of the VINI using Unity 3D, a game engine, which integrates images, animations, video and 2D or 3D models into an interactive environment. The interactive features consisted of three ‘home screens’ that were spread across the narrative and depicted the main character surrounded by iconic imagery representing different daily activities (see Figure 6).

PWA can touch the buttons in any order, and recreations of the events appear, using images, text and speech. The main character in each home screen and the recreation of the event was depicted according to the timeline of the narrative (see pre-stroke, post-stroke at home, and post therapy sections below). There was a mix of home and external activities, and the activities remained the same across all the home screens (Figures 4 and 7).

As the literature indicates that a multimodal approach (i.e. a combina-tion of visual, verbal, text and body language) is most conducive for informa-tion dissemination for PWA, the programmer incorporated one-line text and slow spoken words for each screen (i.e. 80 words per minute; text at a 3rd-grade reading level). This was paired with the words emerging on the screen from a gray field. This is shown in some of the screenshots of the VINI where there is a mix of black and gray text. The narrative was divided into seven sections as depicted and described below: typical daily life; stroke occurrence; hospital stay; post-stroke at home; post-stroke therapy; post therapy (improving); and healing with the passage of time and support from family and friends.

Seven sections of VInI1. Typical daily life: the artists developed a non-gender specific avatar to

represent the participant (Figure 7).

figure 6. Interactive home screen. © Stephanie Berrie, Jeramiah Macha and Stacy Elko, 2017.


The avatar is shown performing typical daily routine activities such as rising from bed and getting dressed. At this point, the first home screen appears and the PWA can choose the order in which the character engages in indoor and outdoor activities such as eating breakfast, driving, shopping and eating at restaurants.

2. Stroke occurrence: the VINI next described the particular type of stroke, either an occlusive or hemorrhagic stroke. The stroke was first described using a metaphor of clogged drains or leaking pipes. This was paired with a simple animation of the blood vessel either clogging or leaking in the brain (Figure 5). Also in this section, the VINI described the physical symptoms that might occur such as facial droop (Figure 6), hand and foot disability.

3. Hospital stay: the VINI progressed to reenact the participant’s hospital stay and the myriad of events and tests that occurred, such as temperature, blood pressure, doctor and family visits. This series of images was repeated to simulate the chaos in the hospital. It ended with the patient being released from the hospital (Figure 8).

4. Post-stroke at home: the next sections of the VINI introduced the changes that occurred post-stroke for the PWA, such as the physical and cognitive limitations. The second home screen appeared with the same options for activities but the character was now depicted with a walker. When an activity was selected, the character demonstrated common stroke symptoms such as sitting down during activities due to

figure 7. Gender neutral avatar and activities. © Stephanie Berrie, Jeramiah Macha and Stacy Elko, 2017.


physical limitations and fatigue that accompany them. Additionally, a home health-care provider was also depicted in the activities (Figure 9).

5. Post-stroke therapy: this section illustrated the avatar/participant in group and individual therapy situations with physical, speech, and occupational therapy scenarios. Time in therapy was shown by passing calendar pages, and the therapy scenes were repeated to indicate that this process would take time (Figure 10).

6. Post therapy (improving): the final home screen appeared and the activities depicted the character with improved mobility and cognitive abilities. Specifically, the walker was replaced with a four-pronged cane and depicted the character as having more typical pre-stroke interactions with others (Figure 11).

7. Healing with the passage of time and support from family and friends: in concert with the recommendations of the experts in the field of aphasia, the VINI ended on a positive note showing that PWA were still able to laugh, appreciate art, music, and love, and be loved (Figure 11).

C O n C l U S I O n

The current article has provided guidelines and examples for health providers looking to rethink patient–provider communication through visual commu-nication. Although visual communication is only one piece of the equation for addressing communication difficulties for PWA, it is perhaps the founda-tion and main conduit through which information can be communicated to them. Therefore, it is imperative to effectively create visuals that are specifi-cally designed to accommodate PWA’s physical and cognitive–linguistic chal-lenges while simultaneously taking advantage of their intact cognition and visual processing.

Future research will determine if the visuals, in combination with the narrative and interactive features of the VINI, can engage and edu-cate PWA about their diagnostic and prognostic health information. Such research should focus on comparing the advantages afforded by the VINI to traditional methods of presenting health information in clinical settings

figure 8. Hospital stay. © Stephanie Berrie, Jeramiah Macha and Stacy Elko, 2017.


(i.e. verbal explanations from health professionals), as well as utilizing psycho-physiological measurements (i.e. heart rate and skin conductance levels) of PWA to accurately assess cognitive processing of information that self-report measures may miss due to PWA’s communication deficiencies. The current article demonstrates the creative process, the visual design considerations, and the interdisciplinary effort (i.e. health professionals, artists, and communica-tion scholars) necessary for visually communicating with PWA, whether the content is health information or any other beneficial content that may help PWA improve their lives during and after rehabilitation.

figure 9. Post-stroke limitations. © Stephanie Berrie, Jeramiah Macha and Stacy Elko, 2017.

figure 10. Therapy sessions. © Stephanie Berrie, Jeramiah Macha and Stacy Elko, 2017.


f U n D I n g

The authors received a SGIR (Seed Grant for Interdisciplinary Research) from the Office of the Vice President of Research at Texas Tech University and an AIM (Arts in Medicine) from the CH Foundation to create the paper pro-totype and conduct the pilot testing. They would like to thank the graduate students of the Texas Tech University School of Art, Media & Communication and the Texas Tech University Health Sciences Center Department of Speech, Language and Hearing Sciences for assistance in image creation, testing and data collection. There is no conflict of interest.

O R C I D I D

Stacy Elko https://orcid.org/0000-0002-9130-0978

R E f E R E n C E S

Bartlett G et al. (2008) Impact of patient communication problems on the risk of preventable adverse events in acute care settings. CMAJ: Canadian Medical Association Journal 178(12): 1555–1562.

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Demaerschalk B, Hwang H and Leung G (2010) US cost burden of ischemic stroke: A systematic literature review. American Journal of Managed Care 16(7): 525–533.

Duh E et al. (2016) Applications of paper and interactive prototypes in designing telecare services for older adults. Journal of Medical Systems 40(4): 1–7.

Eslinger PJ and Damasio AR (1981) Age and type of aphasia in patients with stroke. Journal of Neurology, Neurosurgery, and Psychiatry 44: 377–381.

Holsanova J (2012) New methods for studying visual communication and multimodal integration. Visual Communication 11(3): 251–257.

figure 11. Assessment of healing. © Stephanie Berrie, Jeramiah Macha and Stacy Elko, 2017.

https://orcid.org/0000-0002-9130-0978


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B I O g R A p h I C A l n O T E S

STACY ELKO is an Associate Professor at Texas Tech University where, as an artist/teacher in the School of Art, she teaches printmaking and interdisci-plinary practices. Influenced by a 10-year residence in Morocco, she creates artworks that explore social commentary and question the human relation-ship with their environment. Her current research is using art in conjunction with other disciplines to augment the user experience of music, medicine, and other creative practices. These collaborative ventures draw upon her strengths in not only art and design but also multimedia serious game research to create engaging interactive environments for education and health.Address: School of Art, Talkington College of Visual and Performing Art, Texas Tech University, 3010 18th Street, Lubbock, TX 79409, USA. [email: [email protected]]

JOHN A VELEZ is an Assistant Professor in The Media School at Indiana University Bloomington. His teaching and research focuses on the effects of interactive media at the individual, interpersonal and societal levels. His research examines the benefits of video games not only as an entertainment medium but as tools that help solve common issues in the areas of education, healthcare, social movements, and workplace environments. His research can be broadly divided into the interpersonal, well-being, and learning benefits of video games/interactive media.


Address: Communication Science Unit, The Media School, College of Arts & Sciences, Indiana University, Bloomington, IN 47405, USA. [email: [email protected]]

MELINDA CORWIN is a Professor at Texas Tech University Health Sciences Center and a licensed and certified speech-language pathologist. Since 1998, she has directed the Stroke & Aphasia Recovery (STAR) Program, a com-munity outreach program that provides speech therapy, education, and life participation opportunities to PWA and their caregivers. She has provided speech–language therapy to adult PWA for 25+ years. She has also conducted and published research in the areas of augmentative and alternative forms of communication as well as speech–language therapy for persons with aphasia.Address: Department of Speech, Language, Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA. [email: [email protected]]

JUSTIN ROBERT KEENE is an Associate Professor in the College of Media and Communication at Texas Tech University. He is currently the Director of the Cognition and Emotion Lab in the Center for Communication Research in the College of Media & Communication at Texas Tech. He conducts research on how changes in message features and changes in context effects affect mes-sage processing over time. He has advanced statistical training for the analysis of physiological and self-reported responses, specialized training in the cre-ation and implementation of psychophysiological experiments, and research experience exploring how psychophysiology can be used to assess information processing over time.Address: Journalism & Creative Media Industries, Cognition & Emotion Lab, College of Media & Communication, Texas Tech University, Lubbock, TX, USA.[email: [email protected]]

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