Introduction: People with post-stroke aphasia often encounter significant difficulty communicating in noisy environments. This challenge has been linked to social withdrawal, stress, and reduced participation in daily life. While behavioural measures offer some insight, they may not fully capture the cognitive cost of listening. Here we used pupillometry to objectively measure listening effort in people with aphasia during a speech-in-noise task.
Methods: Twenty adults (10 with chronic post-stroke aphasia; mean age 58 years, and 10 age-matched controls) completed a speech-in-noise task at individualised thresholds (50% and 84% intelligibility). Pupil dilation was recorded using an EyeLink 1000 eye tracker. Analyses included summary pupil metrics (mean, peak, peak latency) and pupil response trajectories using growth curve analysis.
Results: While summary metrics did not differ significantly between groups, growth curve modelling revealed a significant group difference in the slope of pupil dilation over time (first-degree polynomial; p < 0.001). Individuals with aphasia exhibited prolonged pupil dilation during listening, reflecting sustained listening effort compared to controls.
Conclusion: People with post-stroke aphasia show sustained effort when listening in noisy environments - even when audibility is individually adjusted. This sustained effort may help to explain fatigue and social withdrawal often reported in people with aphasia.
Relevance to Clinical Practice or Patient Experience: Listening effort highlights the hidden cognitive cost of everyday communication for people with post-stroke aphasia. These findings can inform clinical assessment and support the development of targeted strategies, including environmental modifications and assistive technologies, to enhance participation and reduce communication-related fatigue in this population.