High-context images: Comprehension of main, background, and inferential information by people with aphasia

Sarah E. Wallace, Karen Hux, Jessica Brown, Kelly Knollman-Porter

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Professionals often recommend using high-context images as expressive and receptive communication supports, even though researchers know little about the information people with aphasia can extract from these images.Aims: This study's purposes were to compare the accuracy and speed with which people with and without aphasia derive main action, background, and inferential information from high-context images.Methods & Procedures: Twenty people with and 20 people without neurological impairment selected high-context images to match spoken sentences conveying main action, background, or inferential information. Participants listened to each sentence presented twice and selected the target image from a field of four. Computation of nonparametric statistics allowed accuracy and speed comparisons between participant groups and among the three stimulus sentence conditions. Additionally, the researchers computed correlations between participants' standardised test scores and their accuracy and speed when performing the experimental task.Outcomes & Results: Task performance by participants without aphasia was more accurate and faster than that of participants with aphasia regardless of sentence condition. Both groups were most accurate and fastest given sentences conveying main actions. The participants with aphasia were significantly slower and less accurate when selecting high-context images to match sentences relaying background and inferential information than ones relaying main action information. This pattern differed from that of participants without aphasia who demonstrated a significant decrease in accuracy only for inferential sentences; they demonstrated significantly different response speeds among all sentence conditions. No significant correlations emerged between Western Aphasia Battery-Revised Aphasia Quotient scores or Cognitive Linguistic Quick Test Executive Functioning or Visual Spatial Domain scores and participants' accuracy or speed of experimental task performance. However, accuracy and speed in some of the sentence stimulus conditions correlated significantly with auditory comprehension subtest scores of the Comprehensive Aphasia Test. All significant correlations indicated that accuracy increased and response speed decreased as auditory comprehension scores increased.Conclusions: Participants with aphasia performed with less accuracy and were slower at responding than participants without aphasia. The fact that participants with aphasia took about twice as long to respond on average as participants without aphasia highlights the need for ample processing time when interacting with people with aphasia. However, despite their aphasia severity as measured by standardised testing, some participants performed well regardless of whether a stimulus sentence referenced main action, background, or inferential information. The results suggest that many people with aphasia can derive substantial information from high-context images.

Original languageEnglish (US)
Pages (from-to)713-730
Number of pages18
Issue number6
StatePublished - Jun 2014


  • Aphasia
  • Communication supports
  • Comprehension
  • High-context images
  • Inferences

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Language and Linguistics
  • Developmental and Educational Psychology
  • Linguistics and Language
  • Neurology
  • Clinical Neurology
  • LPN and LVN


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