Gail Ramsberger

Commonalities and differences in the working memory components underlying letter and category fluency tasks: A dual-task investigation

This study used a dual-task interference paradigm to test the hypothesis that different subcomponents of working memory differentially contribute to performance on letter fluency and category fluency tasks. College students (N = 96) performed each type of verbal fluency task in isolation and concurrently with I of 3 secondary tasks. The secondary tasks were chosen for their putative involvement in different working memory subcomponents. Two subsystems of working memory, the phonological loop and the visuospatial sketchpad, were identified as important contributors to fluency performance, especially to performance on letter fluency and category fluency tasks, respectively. Moreover, the results also suggest that the executive function, mental set shifting, may be deployed to perform both letter fluency and category fluency tasks.

Treatment of agrammatism in long‐term Broca's aphasia

This study describes the response of six, long-term (mean = 7.9 years) aphasic patients to a treatment programme (HELPSS) for agrammatism. Comparison of dependent test scores obtained before and after treatment showed that significant improvement occurred in verbal expression as measured by the Northwestern Syntax Screening Test (Lee, 1968) and the Boston Diagnostic Aphasia Examination (Goodglass & Kaplan, 1972). These results indicate that differential aphasia therapies designed for specific aphasia syndromes can be effective even when administered many years after onset of aphasia.

Achieving conversational success in aphasia by focusing on non-linguistic cognitive skills: A potentially promising new approach

Background : Recent reports from a variety of labs have demonstrated that some patients with aphasia have concomitant non-linguistic cognitive compromises, especially in the area of attention/executive functions. Recent findings also suggest that attention/executive functions may play an important role in the conversational success of persons with aphasia. Aims : This paper provides a review of recent work being carried out in a number of centres having to do with treatment of attention/executive function problems in persons with aphasia. Main Contribution : Although results of the studies reviewed herein must be interpreted with caution, there is growing support for the notion that attention/executive function skills in persons with aphasia are remediable, and that there is an important relationship between attention/executive function and functional communication in people with aphasia. The results suggest that treatment of attention/executive function in aphasia—even in people many years post-onset—may result in measurable changes in attention/executive function skills and in the transactional success of conversational communication. Conclusions : Of course further research must be completed in order to provide clinicians with adequate evidence for clinical decision making. However, this line of research represents a promising new direction in aphasia rehabilitation.

Measuring transactional success in the conversation of people with aphasia

Background: Conversation is one of the most important forms of human communication. The way in which one participates in conversation is necessarily impacted by aphasia. Recent changes in delivery of rehabilitation services place greater emphasis on functional outcome and this, in turn, has been a catalyst for the development of rehabilitation approaches that focus on conversation. However, an important missing element in studies of the efficacy of such approaches is a method for evaluating success in conversation. Aims: The object of this study was to develop an ecologically valid and reliable measure of transactional success in conversation. Methods & Procedures: The procedures for measuring transactional success in conversation described in this study utilizes standardized procedures while simulating natural conversations as much as possible. It provides a method for measuring what has been understood/exchanged when the conversation concludes, and affords an external reference against which the accuracy of this information can be judged. Data for this study were gathered from 14 people with aphasia of moderate severity each of whom engaged in 4 semi-structured conversations with unfamiliar partners. Outcomes & Results: The method of measuring transactional success in conversation described in this study was shown to have good validity and reliability. Conclusions: Transactional success in conversation is clearly a unique construct that is not predicted by traditional aphasia assessment. The method for measuring transactional success in conversation developed in this investigation provides a much-needed means for clinicians to evaluate the efficacy of conversation therapy. Furthermore, combining this new measure with Conversation Analysis (CA) offers a potentially powerful tool to identify those conversational behaviors that contribute to successful transfer of ideas. Such information could then be used to inform the design of treatment programs that seek to improve conversational success for people with aphasia.

Primary Progressive Aphasia in a Bilingual Woman

Multilingual aphasias are common because most people in the world know more than one language, but little is known of these syndromes except in patients who have had a stroke. We present a 76-year-old right-handed woman, fluent in English and Chinese, who developed anomia at age 70 and then progressed to aphasia. Functional neuroimaging disclosed mild left temporoparietal hypometabolism. Neurolinguistic testing was performed in both English and Chinese, representing a unique contribution to the literature. Results revealed conduction-like aphasia that was comparable in the two languages, although English was slightly better preserved. Primary progressive aphasia has disrupted 2 languages in a similar manner, suggesting their close neuroanatomic relationship in this case.

Best Practices for Incorporating Non-Aphasia-Specific Apps into Therapy

Given the proliferation of tablets and smartphones, there is a rising desire to use these technologies and apps in clinical practice. This article offers best-practice guidelines for integrating apps into aphasia rehabilitation. In concert with evidence-based practice guidelines, it describes the steps for deciding which apps to consider and how to judge their appropriateness. We recommend a process for selecting apps that involves three stages. The first step is no different than that used in traditional treatment planning. It involves assessing the clients speech and language, selecting the focus of treatment, and identifying evidence-based approaches to addressing this focus. When technology is being considered, however, it is also necessary to assess sensory, motor, and cognitive requirements of the apps and hardware being considered, as well as the clients ability to operate this technology. Finally, the clinician must consider hardware and Internet demands of the app and whether these are accessible to the client. We illustrate the process through a description of three cases for which we used apps that were not specifically designed for aphasia to deliver evidence-based treatments.

Comparison of outcomes before and after implementation of a water protocol for patients with cerebrovascular accident and dysphagia.

ABSTRACT The aim of this study was to investigate the impact of a water protocol on the incidence of aspiration pneumonia in persons with cerebrovascular accident and dysphagia admitted to an acute neurologic rehabilitation setting. Retrospective chart review and cohort matching of persons with dysphagia admitted before and after the implementation of a water protocol were carried out. The incidence of aspiration pneumonia was higher in the cohort control group-those patients admitted during the years before the implementation of a water protocol. No persons with dysphagia who received water, even if known aspirators of thin liquids, developed aspiration pneumonia. Our findings support the premise that even in known thin liquid aspirators, offering water does not increase incidence of aspiration pneumonia.

Analysing speech problems in a longitudinal case study of logopenic variant PPA

Background: Primary progressive aphasia (PPA) is a neurodegenerative form of dementia in which gradually worsening language impairments are the prominent feature in the initial stages. PPA is commonly differentiated into three variants: nonfluent agrammatic (PPA-NVF), semantic (PPA-SV), and logopenic (PPA-LV). Aims: This article provides a longitudinal description of changes in picture description produced by a woman with PPA-LV, introduces a reliable new measure that captures those changes, and relates the measured changes to raters’ perceptions of changes in discourse quality. Method & Procedures: Seven oral descriptions of the Boston Diagnostic Aphasia Examination (BDAE) Cookie Theft picture were digitally recorded over the course of 27 months and later transcribed. Transcriptions were analysed using a new adaptation of the Linguistic Communication Measure (LCM) and the Linguistic Communication Measure-Revised Cantonese (LCM-RC) designed to be sensitive to the features of PPA-LV. We have named this third form the LCM, the Linguistic Communication Measure–-Speech Sounds (LCM-SS). Audio recordings of the seven picture descriptions plus three produced by typical speakers of similar age were rated for goodness by 15 raters. Outcomes & Results: Goodness ratings of the participants’ speech samples decreased steadily over the 27 months. Although our previous measures of discourse quality (LCM, LCMC-RC) appeared to work well for capturing many of the speakers with vascular aphasia, they failed to capture the nature of this participant’s decline: Her lexical access slowed over time, but did not become more error-prone, and morphosyntactic components did not worsen, with errors remaining low to almost absent. However, speech sound errors and repetitions increased steadily over the 27 months. The new measure, LCM-SS, succeeded in capturing this pattern of decline: Several of the LCM-SS measures were highly correlated to ratings of goodness, and two of the LCM-SS indices (sound errors and grammatical errors) accounted for 98% of the variance in the goodness ratings. Conclusions: Over the course of 27 months, the most significant change in this participant’s Cookie Theft descriptions was the steady increase in sound errors, in the context of decreased efficiency in lexical retrieval and relatively stable grammatical form. This pattern was also highly related to listeners’ perceptions of the quality of discourse. Neither of the previous versions of the LCM captured this debilitating increase in sound errors, but adding the index of sound errors to those previous versions resulted in an analysis method that was sensitive to the linguistic features exhibited by this participant with PPA-LV.

Naming practice on an open platform for people with aphasia

Banga is a software system that uses the Android open source software platform for mobile phones to support word finding practice, a form of therapy for people with aphasia. By connecting to a Web site, Banga provides for remote monitoring and management of the therapy, making it easier for patients to participate in treatment, and for clinicians to deliver it.

Naming practice for people with aphasia in a mobile web application: early user experience

Bangaten is a new version of Banga [2,3], a smart phone application that supports word finding practice, a form of therapy for people with aphasia. Early user experience shows that Bangaten offers useful cross-platform operation, on both Android and iPhone devices, including remote management of a clients device. Bangaten demonstrates the growing usefulness of emerging HTML5 technology for implementing assistive technology applications, while also illustrating some remaining limitations.