Francine Giroux

Towards a description of clinical communication impairment profiles following right-hemisphere damage.

Background: It is estimated that approximately 50% of individuals who incur right‐hemisphere damage (RHD) have subsequent communication disorders. Lexical‐semantic, discourse, prosodic, and pragmatic deficits have been reported following RHD, but the co‐occurrence of these deficits within the same individual has not yet been systematically investigated. Therefore clinical profiles of communication impairments in individuals with RHD still have to be identified and described in order to appreciate their communication impairment and provide strategies for rehabilitation. Aims: The goal of the present study was to explore the clinical profiles of communication impairments subsequent to a right hemisphere lesion. Methods and Procedures: A total of 28 French‐speaking individuals with a right‐hemisphere lesion were evaluated using the Protocole MEC (Joanette, Ska, & Côté, 2004), a normalised battery allowing the assessment of communication deficits after RHD. A hierarchical cluster analysis was used to group participants according to similarities in their results on the 14 tasks. Outcomes and Results: Four subgroups of RHD individuals were identified on the basis of the overall similarities of performance on the 14 tasks of the Protocole MEC. Participants in the first cluster showed impairments in all four language components evaluated, whereas the second cluster of participants was also impaired in prosodic, lexical‐semantic, and pragmatic abilities, but was characterised by a relative preservation of discourse abilities. The third cluster of participants did not show any abnormal results. Finally, two individuals were mainly characterised by some lexical‐semantic deficits. Conclusions: The Protocole MEC used in conjunction with a cluster analysis provided a first step towards the identification of communication impairment profiles among the population of individuals with RHD. In the present study it was not possible to clearly identify the relationship between a given profile and factors such as lesion site, age, or education. Incidence of communication impairments was estimated to be higher in a rehabilitation centre setting than the generally accepted 50% in the literature.

An intelligent videomonitoring system for fall detection at home: perceptions of elderly people

We explored the perception and receptivity of elderly people regarding the introduction of an intelligent videomonitoring system (IVS) at home. Using a mixed methods design, 25 elderly people with a history of falls completed a structured interview (two questionnaires). In the year preceding the interview, 72% of the participants fell as many as seven times. Open-ended questions (qualitative data) were used to supplement the quantitative data. A content analysis (qualitative data) and a descriptive analysis (quantitative data) were carried out. The participants were 84% favourable or partially favourable to technologies which ensured home security and 96% favourable or partially favourable to the IVS. About half (48%) said that they would use it. The other participants did not wish to use it unless they had been left to live alone or if their health condition worsened. Thus the living conditions of the elderly appear to influence their perception and receptivity regarding the acceptance and use of an IVS.

The heterogeneity of picture-supported narratives in Alzheimer’s disease

This study describes discourse patterns produced by 46 Alzheimer disease (AD) patients and 53 normal elderly subjects in two picture-supported narratives. Nine measures derived from a cognitive model of discourse processing were obtained and submitted to cluster analysis. Results indicate that discourse patterns elicited from both stimuli were heterogeneous. Further, they fail to clearly differentiate between normal aging and AD in half of the AD patients. Discourse patterns are examined in light of various sources of heterogeneity including severity of cognitive impairment, subject characteristics, and task demands. The usefulness of discourse as a diagnostic and therapeutic tool is discussed.

Changes in Health Outcomes among Older Husband Caregivers: A One-Year Longitudinal Study:

This one-year longitudinal study carried out on a sample of 232 older husband caregivers sought to describe changes in psychological distress and self-perceived health, and to examine relationships between factors drawn primarily from Pearlins model of caregiving and changes in these two health outcomes. Prediction analyses shows that nearly two thirds of the husbands have unsuccessful outcomes with respect to these two dimensions, that is, most husbands obtain either steadily poor scores at both times of the study or worse scores on one or both outcomes. Higher levels of education and informal instrumental support at time 1, as well as an increase in role overload, are predictive of unsuccessful outcome for psychological distress, whereas an increase in self-efficacy predicts successful outcome for self-perceived health. Overall, husband caregivers vary in their response to caregiving over time. The findings support previous study results showing subjective stressors, rather than objective stressors, and caregiver resources to be significant predictors of caregiving outcomes.

Follow-up of an intervention program for caregivers of a relative with dementia living in a long-term care setting: Are there any persistent and delayed effects?

The purpose of this randomized study was to test the persistent and delayed effects of an intervention program entitled “Taking Care of Myself ” on selected mental health outcomes of daughter caregivers of a relative with dementia living in a long-term care setting. One group of caregivers took part in the experimental program (EG, n = 45), one in a comparison program offered by an Alzheimer Society (AG, n = 51), and another constituted a control group (CG, n = 41). Effects were verified at the end of the program and 3 months later. Results from prediction analyses reveal that competence dealing with healthcare staff and use of the coping strategy of reframing were persistent effects unique to the EG condition, whereas perceived availability of informal and formal support was a persistent effect in the EG and in the AG. A delayed effect was observed in the AG regarding competence dealing with healthcare staff. These results underline the importance of follow-up assessments of intervention programs and suggest avenues to support caregivers of institutionalized seniors.

‘Taking Care of Myself’ Efficacy of an intervention programme for caregivers of a relative with dementia living in a long-term care setting

The purpose of this randomized study was to test the efficacy of an intervention programme entitled ‘Taking Care of Myself’ on selected indicators of mental health of daughter caregivers of elderly parents with dementia living in a long-term care setting. The programme is based on an empowerment perspective and on a stress and coping theoretical framework. Three groups of caregivers were compared: one took part in the experimental programme (EG, N= 45), one in a comparison programme offered by a Quebec Alzheimer Society (AG, N = 51), and another was a control group (CG, N = 41). Two successful outcomes are unique to the EG condition, that is, competence dealing with health care staff and perceived challenge of the caregiver role. Prediction analyses also provide statistical support for the efficacy of the EG and AG conditions to produce successful outcomes with respect to common indicators (perceived threat and role overload, control by self, informal/formal social support, and use of the coping strategy of reframing). These results provide avenues of intervention for promoting the mental health of caregivers of an institutionalized relative.

Predicting longitudinal patterns of psychological distress in older husband caregivers: further analysis of existing data.

Further analysis of existing data from a previous longitudinal study of older husband caregivers sought to determine whether primary objective and subjective stressors drawn from Pearlins model of caregiving could predict three patterns of psychological distress observed in the sample over 1 year: (a) stable high (n = 115), (b) stable low (n = 44), and (c) rising (n = 46). Results of discriminant function analyses show that subjective stressors (level of role overload, role captivity and relational deprivation) at baseline, distinguish the stable low group of husbands from the stable-high. The results suggest that there is considerable stability over time. Many husband caregivers report high-psychological distress and need help, whereas there is a need of preventive interventions to keep psychological distress low. Implications for singular interventions that target specific factors according to group membership are discussed.

Word fluency after a right-hemisphere lesion.

Joanette and Goulet (Neuropsychologia, 1986, 24, 875-879) reported that right-handed patients suffering from a right-hemisphere stroke were impaired on semantic but not on orthographic criteria when they were submitted to a word fluency task. The interpretation of this dissociation was that the right hemisphere would subtend a particular contribution to the semantic component of word processing in right handers. The goal of the research reported here was to challenge this dissociation. In contrast with the first study, the production criteria were presented randomly and their level of productivity was a controlled factor. The semantic-orthographic dissociation was not replicated under these conditions.

A psycho-educational intervention focused on communication for caregivers of a family member in the early stage of Alzheimer’s disease: Results of an experimental study:

A psycho-educational intervention focused on communication was conceived for caregivers of family members in the early stage of Alzheimer’s disease (i.e., persons with dementia), and tested on five proximal outcome variables: caregiver knowledge, perceptions of communication difficulties and degree of perceived disturbance related to these difficulties, self-efficacy and skills. Guided by a theoretical framework that encompassed geragogy, the McGill model of nursing and self-efficacy theory, the intervention was evaluated via an experimental design with pre-post tests. Fifty family caregivers were randomly assigned to an experimental group (intervention program), or to a control group (information flier on communication and memory). Statistically significant effects were found on four dependent variables: caregiver knowledge, degree of disturbance related to communication difficulties, self-efficacy and skills. No significant effects were observed in regard to the perceived presence of communication difficulties. This communication program serves as a useful tool to prepare caregivers for their new role.

Syntactic processing in bilinguals: An fNIRS study

The study of the neural basis of syntactic processing has greatly benefited from neuroimaging techniques. Research on syntactic processing in bilinguals has used a variety of techniques, including mainly functional magnetic resonance imaging (fMRI) and event-related potentials (ERP). This paper reports on a functional near-infrared spectroscopy (fNIRS) study on syntactic processing in highly proficient young adult speakers of Portuguese (mother tongue) (L1) and French (second language) (L2). They made a syntactic judgment of visually presented sentences, which either did or did not contain noun-verb agreement violations. The results showed that syntactic processing in both languages resulted in significant activation in anterior frontal regions of the left hemisphere and in the temporal superior posterior areas of the right hemisphere, with a more prominent activation for L2 in some areas. These findings corroborate previously reported neuroimaging evidence, showing the suitability of fNIRS for the study of syntactic processing in the bilingual brain.