Treating Discourse with Jessica Obermeyer

Interviewer info

Lyssa Rome is a speech-language pathologist in the San Francisco Bay Area. She is on staff at the Aphasia Center
of California, where she facilitates groups for people with aphasia and their care partners. She owns an
LPAA-focused private practice and specializes in working with people with neurogenic communication disorders.
She has worked in acute hospital, skilled nursing, and continuum of care settings. Prior to becoming an SLP, Lyssa
was a public radio journalist, editor, and podcast producer.
In this episode, Lyssa Rome interviews Jessica Obermeyer about group treatment for aphasia.

Guest info

Jessica Obermeyer, PhD, CCC-SLP, is an Assistant Professor in the Department of Communication Sciences and
Disorders at the University of North Carolina at Greensboro. Her area of specialization is acquired adult
neurogenic language disorders. Dr. Obermeyer's research interests include discourse production in aphasia,
treatment efficacy, and the cognitive requirements of language production. Prior to earning her doctorate, she
worked in a variety of clinical settings where she specialized in assessment and treatment of adult neurogenic
populations.

Listener Take-aways
In today's episode you will:
● Recognize the role of written communication in clients' daily activities, including texting, email, and
online tasks.
● Adapt ARCS-W treatment components to match each client's preferred writing modality (handwriting vs.
typing).
● Identify candidates with aphasia who are well-suited for discourse-level writing treatment.

Lyssa Rome
Welcome to the Aphasia Access Aphasia Conversations Podcast. I'm Lyssa Rome. I'm a speech
language pathologist on staff at the Aphasia Center of California, and I see clients with aphasia and
other neurogenic communication disorders in my LPAA-focused private practice. I'm also a member of
the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with
information, inspiration, and ideas that support their aphasia care through a variety of educational
materials and resources.

I'm today's host for an episode that will feature Dr. Jessica Obermeyer, who was selected as a 2024
Tavistock Trust for Aphasia, Distinguished Scholar, USA and Canada. Dr. Obermeyer is an assistant
professor in the Department of Communication Sciences and Disorders at the University of North
Carolina at Greensboro. Her area of specialization is acquired adult neurogenic language disorders. Dr
Obermeyer's research interests include discourse production and aphasia treatment efficacy and the
cognitive requirements of language production. Prior to earning her doctorate, she worked in a variety
of clinical settings, where she specialized in assessment and treatment of adult neurogenic populations.
Jessica Obermeyer, welcome to the podcast, and thanks for being here.

Jessica Obermeyer
Thank you. It's a pleasure.

Lyssa Rome
So I wanted to get started with a question we often ask, which is: How did you get into this? Was there
an aha moment for you and what led you to research aphasia?

Jessica Obermeyer
That's a great question. I think it was more of a slow awakening and journey to realizing that this is how
I wanted to spend my days. When I started studying speech language pathology, I knew I wanted to
work in adult rehab with people with traumatic brain injury, stroke, and aphasia. But as an
undergraduate and a masters student, I worked on a lot of research related to traumatic brain injury and
cognition. But then I had some exposure to aphasia research, and as a clinician, I just loved working
with people that had aphasia. I loved running aphasia groups. I started aphasia groups, and when I
decided to go back for my PhD, that is what I wanted to focus on. I also had the opportunity to work in
adult outpatient, so I got to see a lot of people that had aphasia and were at different points in their
rehabilitation journey. And those experiences just made me want to continue and especially do
research that could develop and evaluate different treatment approaches for people that had aphasia.

Lyssa Rome
One of the sort of through lines in your research has been discourse. And I'm curious about how you
landed on that as the focus of your work, why discourse?
Jessica Obermeyer
It's how we talk. It was always, you know, something I was interested in. I think, as a clinician, I felt
really daunted by discourse, because it is laborious, you know, it takes a lot of time to think about how
you're going to analyze it. But I was always so fascinated by all the linguistic components that make up

discourse as a clinician. And then I think as a researcher, I really appreciate how important it is.
Everything we do in our day to day lives is often at a discourse level, and that looks so different
depending on the type of discourse. So your text exchange is discourse, your emails, your
conversations, the interaction with a barista. You know, every kind of functional way that we
communicate is often at a discourse level. But it's so different depending on what that interaction looks
like, and that's just endlessly fascinating to me as a researcher… challenging but fascinating.

Lyssa Rome
Challenging both to evaluate and, I guess, to some extent, to treat. One of the things that I really
appreciate is that it's how we communicate in our daily lives, and so if we're thinking about life
participation and sort of functional approaches to treatment, to my mind, discourse is kind of where it's
at. So I'm really excited to get to talk to you more about it. So speaking of discourse, I thought we could
talk about your work on ARCS. Maybe we could start by telling us a little bit about the origins and how
you became involved in researching.

Jessica Obermeyer
Yes, I'd be happy to. I started doing research with ARCS as a doctoral student. So it's been a long time,
but the origin of ARCS, or Attentive Reading with Constrained Summarization, started with Yvonne
Rogalski and Lisa Edmonds, and they published the first paper, I think, in 2009, but someone should go
back to check that, and it was originally for someone that had primary progressive aphasia. And then
there was another paper published for two people with Wernicke's aphasia.

So in the original version, it's based on constrained summarization, and constrained only in that you're
giving someone guidelines for how to summarize so they have to read through a segment of text.
Usually it's a current event article, but clinically, you could use pretty much any written text. And I've
actually done it with someone listening as well.

Typically with ARCS, you would have someone read a segment of written text and then summarize it
with the constraint or guideline to be specific. So avoid words like it, stuff, thing, he, she. So use that
really intentional word retrieval. That's not what we typically do. We often use non-specific words, but
it's that therapeutic, like try to go for the really precise and specific word exercise that retrieval and to
also stay on topic, so try not to add a tangent, or, you know, additional information that's not related to
what you're reading. And then in my work, I've added an additional guideline that's just based on what
that person needs. So if they're repeating a lot, then that might be part of the guideline. Often, the
guideline is to try to include the essential information that you've identified already.

So that's the origin of ARCS. And as a doctoral student, I really wanted to do treatment research. I
became really interested in cooperative learning theory, in how people can work together in their
learning, collaborate to improve learning. And when I was doing that, reading and thinking about
cooperative learning, writing seemed like such an excellent tool for that, because I think one of the hard
things about spoken language is that it's just gone. You say it, it's gone. It's very hard to monitor, which
I'm acutely aware of right now in this recording.

But with written text, you have this wonderful record of what you've produced, and that can be really
helpful for thinking about language and planning, especially in an approach like ARCS or ARCS-W that
emphasizes this planning, process-driven component, where you're thinking about, "What do I need to
include in this discourse? What's important? What's not important? And what have I actually produced?
Does that meet, you know, the guidelines I've tried to meet?" So that's how writing actually got pulled
into it. And I wanted to keep the spoken language because, I don't know that I've ever met someone
with aphasia who told me they didn't want to continue exercising their spoken language, but the writing
was just I think, an important addition, because there are so few written discourse treatment options.
And it allowed for this emphasis on monitoring and planning and some of the cognitive components of
discourse that can be hard to address.

Lyssa Rome
And maybe you could say a little bit about what you found when you've studied ARCS-W, so the
Attentive Reading and Constrained Summarization-Written.

Jessica Obermeyer
Well, people have improved, which is great. So the one of the things about ARCS and ARCS-W that's
maybe unique when we think about aphasia treatment as a whole, is that it's not a treatment with
trained items, so no items are repeated. You're working on the process of discourse production, this
process of monitoring and trying to be specific, be efficient, you know. In written discourse, people have
made improvements in correct information units or CIUs. So at the word level in discourse, the amount
of informative and correct information that they're producing, people have made improvements at the
utterance level, where they're producing more relevant utterances and more utterances that have a
basic sentence structure, and then
this hasn't been looked at in all of the studies, but for some of the participants, where we've measured
things like main concepts, the amount that the person is conveying the main ideas or concepts in the
discourse has improved for some people as well. And then at this spoken discourse.

So ARCS-W, it's half spoken, half written. Basically, people have also made similar improvements. So
it's been encouraging so far, ARCS-W I would say, compared to ARCS is for people in the more mild
aphasia end of the spectrum, especially with the writing component. Any clinician who's worked with
people with aphasia will know that writing is often a stressful thing for people with aphasia. So it's for
people that are writing at a phrase level already. It doesn't mean that their spelling is perfect, but if
they're really struggling to get out a single word, this is probably not the ideal you know treatment for
them, but for folks that are more on the mild end who want to work on spoken and written discourse, we
have seen some positive results in their spoken and written discourse production.

Another thing that I think is really important for this treatment is that it is so multi-modality. When we
write normally, we're reading as well. You know, we're not just writing in a vacuum. A lot of the time.
We're rereading our text, we are reading that text message and then responding to it. So I like that. I
like multi-modality treatments. I like that this is a treatment that allows people to address multiple types
of language goals, while, you know, keeping it pretty simple and low tech.

Lyssa Rome
I think that that really hits on one of the reasons that I like using ARCS-W in my work with people is that
It can be used with so many different kinds of texts. So I've used both, you know, work emails, if their
goal is to get back to work, newspaper articles that interest them, simplified newspaper articles that
interest there's so many possibilities. And anyway, it's exciting to hear you talk about that.

Jessica Obermeyer
Yeah, I think that as a clinician, that's why I liked ARCS. It was so flexible, so easy to implement. And
that's definitely one of the things I like about ARCS-W as well. Make treatment work hard for you.

Lyssa Rome
So that is interesting to people as well. Where are you going next with your ARCS research?

Jessica Obermeyer
Great question. I'm writing up results from about six people we ran over the last couple years, so that, I
hope, gets submitted for publication soon. And I would really like to adapt this treatment a little further
to use more assistive technology for folks that are really wanting to write, but aren't wedded to
handwriting or typing in a traditional sense. So can we use speech-to-text? I always mix it up. And can
we use methods to support people producing written language that are, you know, different than just
typing it? Because people have really different needs in their life. So if that is a way to meet their writing
needs, excellent, and I'd like to do that in the future.

Lyssa Rome
I think that gets back to this idea that it's so flexible, right? You could adapt it in so many different ways.
I think that that's really exciting, because it sort of further underscores the flexibility of this approach.
And we were talking earlier, before we started recording, about using the same ARCS framework, or
ARCS-W framework for material that clients have listened to, things like podcasts or TED Talks. So it
seems like it's so adaptable, which is part of what I think makes it really exciting.

Jessica Obermeyer
I think that's a great idea. We actually did use listening and then summarization for one of the
participants in the first arc study, because that met their profile. That's how they wanted to interact with
the treatment, and it worked out really well for them, and it's a great way to incorporate people's
different interests. Not everyone wants to read, so being able to listen is a great option. And in the
treatment for everybody, they always select their writing modality so they can either hand write or type,
depending on what's relevant for them. In the population of people that have aphasia now, and I know
that this will change over time, people have really different comfort levels with technology and with
typing. So if someone says, "No, I never typed. I want to handwrite," then we can do that. And if, if it's
the other, we can type. So I think listening is just another way to make it meet someone's needs better.

Lyssa Rome
I was hoping that you could talk a little bit more about the similarities and differences between different
types of discourse. So spoken and written discourse, typed and versus handwritten discourse. Tell us a
little bit more about that.

Jessica Obermeyer
Yeah, of course. Well, I should, I guess, start off by saying, working on the ARCS-W treatment
research, I recognized just how little information is out there on written discourse and the majority of
discourse measures that we use in aphasiology are based on spoken discourse production. But there
are differences in how we speak versus how we write. So in spoken language, we've already talked a
little bit about this, it's temporal, it's just gone. So writing is tangible. You have a record of your writing,
and that can be really beneficial for people with aphasia. But of course, there's there's other things that
can make writing more challenging as well.

With spoken language, of course, we have the suprasegmental components of what we're saying. So
we have our tone and our facial expression and things that allow us to impart meaning without actually
saying it, and we don't have that in writing. Although things are shifting with text messaging
technologies, we can add emojis and memes that help us communicate information. But I think when
we're thinking about traditional writing, it doesn't have those additional components, and therefore
people have to be more explicit with their word choice and a little more clear in what they're trying to
say. People are often more efficient in writing. They use fewer words than they would in speaking. So
those are some of the differences.

We can't automatically correct our written output because we see that our partner doesn't understand.
Because in writing, there's this distance between when we're writing versus when we think someone's
reading it. Even in more instant platforms like text messaging, we don't know exactly when someone's
reading something or how their face looks when they read it, in the way we know with speaking. So
those differences do impact how we complete the task. And of course, the context of writing changes it
dramatically. So you write notes to yourself really differently than you write a research paper or a work
email. And that's not so different from speaking, right? The context is still going to impact how we speak
or write, very much.

So in my work, I've looked at how writing and typing are the same or different. And this is a pretty new
area. There's a couple papers out there on it now, and I think it's gaining traction, which is great,
because most people write through typing in their daily life now. What I found is that at a group level, it's
pretty similar. Writing and typing look pretty similar for people that have aphasia. But individually it can
be very different. So an individual person with aphasia might have a strength or weakness in
handwriting versus typing for lots of different possible reasons, like their experience, or hemiparesis,
their desire to do one or the other. But it's not, the patterns aren't completely clear. I think clinicians are
probably really used to hearing that every individual with aphasia has the potential to be different. So I
think that keeps with written and typed language output, handwritten and typed.

Some of my recent work has been related to looking at different writing modalities for people with
aphasia. So are there differences in their handwritten versus typed discourse production. There's a
couple papers out on this now, and hopefully there'll be even more as it gains traction. And I think it's
getting more attention in the research literature because of how important writing is in our daily lives
now. I mean, most activities of daily living are now completed through, you know, the virtual world, so
banking, shopping, lots of messaging are completed through reading and writing now.

So that's kind of why I became interested in also working with ARCS-W and having people handwrite
versus type, depending on their interest and comfort level. It was always interesting to me why certain
people picked one or the other, and kind of what I was seeing. There is some research out there that
shows that handwriting is advantageous for learning. So the specificity of how we're moving our fingers
to create letters is helpful for retention and learning items, but when we're thinking at the discourse
level, when we're not using the same items necessarily, things could potentially be a little different.
So I was interested in just exploring some of those differences and patterns that might emerge, and if
there was anything I could figure out that might be driving a pattern. So if someone's better at typing
than handwriting, is there a reason that they're better? So what I have found so far, and it's it's pretty
preliminary, is that at the group level, handwriting and typing look very similar for people with aphasia,
so oftentimes, there's not a big difference in the total words that they produce, and that's been
confirmed by a larger study as well from Jaime Lee and colleagues. But then when we look at the
individual level, that's when you can start to see differences. And I don't think any clinician would be
surprised to hear that people with Aphasia are variable or different. So we know that that is common,
but it's been pretty interesting and striking in my own work to see how at the group level, these
differences just totally even out. But then when we look at individuals, you do see that, you know,
someone is more proficient with typing, someone else is more proficient with handwriting.

So in a study I did, I think from 2024, we had people fill out this historical information about their typing
experience and exposure, we knew about if they had a hemiparesis or not, and so were they able to
use both hands or one hand for handwriting or typing? And like I said, we did find these individual
differences for some people, but there wasn't a really clear pattern in what was driving those
differences? Was it that they hadn't worked with a keyboard a lot? Was it that they only had the use of
one hand? And we just didn't have enough data potentially to discern any specific patterns?

Lyssa Rome
We've talked a little bit about different types of discourse, written, spoken for written, typed versus
handwritten. But I wanted to kind of come back to how we measure and analyze discourse, and wanted
to ask about a more recent paper and have you describe a little bit about your work on discourse
measurement and training clinicians to measure discourse?

Jessica Obermeyer
That paper is a perceptual rating paper. We've talked a lot about discourse in this chat, and I think
probably one of the first things I might have mentioned was how daunting discourse analysis can be.
So researchers are aware of that, and always kind of thinking that discourse is so rich, it provides us so
much information about someone's linguistic ability, but also their success with communication in a way
that other levels of language don't necessarily tell us. So how can we benefit from that rich information
in a way that clinicians can do. Because with discourse analysis, you know, in the clinical session, it
might not take that long. You're having someone participate in 10 minutes of conversation—that is not a
lot of time in your session. The time is all backlogged. The time is after the session is over, and you're
trying to transcribe what they've said and then identify discourse measures that you're interested in.
And another thing that makes discourse just complex and dynamic is that there's not one measure, you
know, there's not a measure of word retrieval and discourse. There are lots of measures that can give
you insight into word retrieval and discourse.

So this project I did with my collaborator, Marion Lehman, who also works on discourse, and especially
conversation. We wanted to see if it was possible to train people to rate conversation samples from
people with aphasia on linguistic measures, so measures of language ability. So there are other
perceptual rating scales, but a lot of them might be looking at speech acts like initiation or presence or
absence of errors. And we were really interested in if these, if perceptual ratings, could map on to the
things we're doing in our labs, so you know, correct information units or the degree of informativeness,
utterances that have basic structure, coherence, you know, these measures that we are spending many
hours, you know, coding line by line, or even word by word, for some.

So she and I developed this training and introduced—so the paper that's published, we used research
assistants in our research labs, and we exposed them to the linguistic measures that we were
interested in. Had them watch some practice videos, and then told them how we had coded them. So
what was the value based on our lab coding? And then we did five test samples, so there were four
linguistic measures. The training lasted about three hours, and I did five test samples. And we got some
really good feedback from the RAs who did the training and rating samples.

We had some promising results for especially two of the measures that we used in their training, and
now we're really interested in extending that work with clinicians. So the people that were in the study
before had very limited experience listening to people that had aphasia. They hadn't worked with
people that had aphasia, they hadn't done extensive clinical training. We're hopeful that if we can use
their feedback to fine tune the training and rating procedures and recruit some clinicians to participate,
that hopefully we could get even better results and hopefully provide a tool to clinicians where they can
be thinking about linguistic components of conversation in a way that's more feasible to their schedule
and their workload, because we recognize how much time it takes. And I think it's, it's just a barrier to
entry, even, because if someone is feeling like, "I can't do this, I don't have time to do this," then it's
hard to even learn about or get started.

Lyssa Rome
Yeah, I'm so happy to hear that you're that you're focused on the feasibility for clinicians who have
productivity requirements, who don't necessarily have a lot of time at the end of the day to
do that kind of really in depth analysis. I think it's exciting.

Jessica Obermeyer
Oh, for sure, and clinicians, I think, work a lot of extra hours, but they have a whole caseload, you
know, so balancing everybody's needs and being able to to provide excellent care to everybody is, is
always a challenge, and hopefully, hopefully we'll, we'll be able to continue this work. We're trying to get
some funding for the project because we want to be able to pay SLPs who participate in the research.

Lyssa Rome
As we start to wrap up, I'm wondering what you would like clinicians who are listening to this podcast to
take away from what we've talked about today, from your work.

Jessica Obermeyer
I think one takeaway would be for clinicians to think about incorporating handwriting and typing into
their existing treatment practice. So I've talked a lot about ARCS-W. ARCS-W is not for everybody. It is
a very specific treatment approach for people that have mild aphasia who want to work on
discourse-level writing. But there are so many ways to have people engage with handwriting and typing
that will serve them in their daily life.

So we've talked a lot about how literacy is just such a big—it's a bigger part of our lives than it was 20
years ago. People can achieve a lot of independence and autonomy if they're able to interact with
reading and writing and complete it successfully. So I would really encourage clinicians to think about
how they can incorporate reading and writing into their existing treatment. A study I was involved with—
Liz Madden surveyed SLPs on their practices assessing and treating reading and writing, and one of
the take-homes from that project was that clinicians evaluate writing more than treating it. And
especially handwriting, versus typing. But I think that given the way society is moving, asking people
like, "What's important for you, handwriting or typing?" and let's make that our practice.

Lyssa Rome
I appreciate how person centered and flexible that advice is right. We're trying to meet people where
they're at and recognizing that our treatment can be tailored to the person who's sitting in front of us.
I'm curious to hear what is coming next for you. What are you excited about in your work?

Jessica Obermeyer
That's actually a great segue about how we can tailor treatment, because that is one of the projects that
I'm working on now, how we can think about treatment in terms of what are the things that make it work,
versus things that maybe aren't essential components of the treatment? With the last study I did with
ARCS-W of the things that we were really trying to understand better was: Did it matter if people hand
wrote or typed? Did they have the same kind of level of generalization to the other writing modality?
And in that study, it doesn't seem that they did. And I think there's really specific reasons for that,
because we're working at this discourse level without repeated items. And so you might not see the
same impact of that handwriting learning boost, because we're not repeating things as often.

That's one of my real interests is thinking about how we work on treatment, how we deliver treatment,
how clinicians can deliver treatment. Because I am very guilty of this. Working on writing takes a long
time. It takes a long time for people with aphasia to produce written discourse level text. So in the
ARCS W studies, it's an hour-and-a-half treatment session where we only work on ARCS-W. But I know
I recognize that that's like not most clinicians' daily life, and it doesn't mirror what therapy many people
with aphasia receive. So thinking about treatment in a more component-based and mechanistic way
that makes it easier for clinicians to adapt to their their practice is is one of the things I would like to
flesh out in the future. And then continuing to work on this training and perceptual rating protocol.
One of the things my colleagues and I would like to do is create a training that can be shared freely,
where clinicians can easily get access to it, and then collect more robust data. I mean, only if we get
good results, of course. If we don't, we will not be sharing it. But those are the big things I'm thinking
about in the next couple of years, and then beyond that, even more.

Lyssa Rome
Well, I look forward to reading more of your work and to seeing what comes next as well. Dr. Jessica
Obermeyer, thanks so much for talking with us. I really appreciate it.

Jessica Obermeyer
It's been a pleasure. Thank you.

Lyssa Rome
And thanks also to our listeners for the references and resources mentioned in today's show. Please
see our show notes. They're available on our website, www.aphasiaaccess.org. There, you can also
become a member of our organization, browse our growing library of materials and find out about the
Aphasia Access Academy. If you have an idea for a future podcast episode, email us at
info@aphasiaaccess.org. Thanks again for your ongoing support of Aphasia Access. For Aphasia
Access Conversations, I'm Lyssa Rome.

Resources
Obermeyer, J. (2024). Using and modifying standardized restorative treatments in aphasia: Clinician
perspectives. American Journal of Speech‑Language Pathology. Advance online publication.
https://doi.org/10.1044/2024_AJSLP-23-00349

Obermeyer, J., Leaman, M., & Oleson, J. (2025). Feasibility and preliminary data for a training protocol
and perceptual rating scale of linguistic conversation measures in aphasia. American Journal of
Speech‑Language Pathology. Advance online publication.
https://doi.org/10.1044/2025_AJSLP-24-00420

Obermeyer, J. A., Rogalski, Y., & Edmonds, L. A. (2021). Attentive reading with constrained
summarization-written, a multi-modality discourse-level treatment for mild aphasia. Aphasiology, 35(1),
100-125.

Obermeyer, J. A., & Edmonds, L. A. (2018). Attentive reading with constrained summarization adapted
to address written discourse in people with mild aphasia. American Journal of Speech‑Language
Pathology, 27(1S), 392–405. https://doi.org/10.1044/2017_AJSLP-16-0200

Obermeyer, J. A., Leaman, M. C., & Edmonds, L. A. (2020). Evaluating change in the conversation of a
person with mild aphasia after Attentive Reading with Constrained Summarization–Written treatment.
American Journal of Speech‑Language Pathology, 29(3), 1618–1628.
https://doi.org/10.1044/2020_AJSLP-19-00078

Obermeyer, J., Edmonds, L., & Morgan, J. (2024). Handwritten and typed discourse in people with
aphasia: Reference data for sequential picture description and comparison of performance across
modality. American Journal of Speech-Language Pathology, 33(6S), 3170-3185