Jacinta Douglas

Correlates of depression in adults with severe traumatic brain injury and their carers

Although it is generally accepted that social support plays a role in the maintenance of psychological well-being, there has been relatively little direct investigation of the role that social support may play in affecting post-injury depressive symptoms and mediating the effects of traumatic brain injury (TBI). Consequently, social support was selected as the framework within which to investigate possible indicators of depression in adults with severe TBI and their carers. The authors were interested in the degree of association between social support and the criterion variable of depression in the context of demographic and disability-related variables that have been identified as significant correlates of depression. Thirty-five adults with severe TBI (PTA > 7 days) and their primary carers participated in the study. Time post-injury ranged from 3.5-10 years and all the participants were living in the community. Fifty-seven per cent of the adults with TBI and 60% of their carers were classified as showing significant symptoms of depression. As hypothesized, social support contributed significantly to the prediction of depression. In particular, strong-tie support appeared to be an important indicator of well-being for both the participants with TBI and their carers.Although it is generally accepted that social support plays a role in the maintenance of psychological well-being, there has been relatively little direct investigation of the role that social support may play in affecting post-injury depressive symptoms and mediating the effects of traumatic brain injury (TBI). Consequently, social support was selected as the framework within which to investigate possible indicators of depression in adults with severe TBI and their carers. The authors were interested in the degree of association between social support and the criterion variable of depression in the context of demographic and disability-related variables that have been identified as significant correlates of depression. Thirty-five adults with severe TBI (PTA > 7 days) and their primary carers participated in the study. Time post-injury ranged from 3.5-10 years and all the participants were living in the community. Fifty-seven per cent of the adults with TBI and 60% of their carers were classified as showing significant symptoms of depression. As hypothesized, social support contributed significantly to the prediction of depression. In particular, strong-tie support appeared to be an important indicator of well-being for both the participants with TBI and their carers.

Measuring perception of communicative ability: the development and evaluation of the La Trobe communication questionnaire

The La Trobe communication questionnaire (LCQ) was designed to measure perceived communicative ability. It was developed to enable collection of information from various sources including the self-perceptions of individuals as well as the perceptions of close others. In this paper we report the development of the questionnaire, its psychometric properties and normative data for the perceptions of young adults and the comparative perceptions of their close others. Participants in the study were 256 adults comprising 147 primary subjects and 109 close others. Primary subjects ranged in age from 16-39 years with a mean age of 20.6 years. The 30 item questionnaire was structured using a modified Likert-type scale with four possible levels of response: (1) never or rarely; (2) sometimes; (3) often; and (4) usually or always. Internal consistency was high (Cronbachs alpha = 0.8596) and good stability over time for self-report was demonstrated (r = 0.7558). There was a significant difference (p < 0.0001) between the perceptions of primary subjects and close others with primary subjects perceiving themselves to have more frequent communication difficulties, than did their close others. Overall, our findings suggest that the LCQ is a promising means of measuring perceived communicative ability in young adults.

The comparative effectiveness of gesture and verbal treatments for a specific phonologic naming impairment

Background: Arm and hand gesture has been considered a potential facilitator of word production (Skelly, Schinsky, Smith, & Fust, 1974), and gesture is often considered as a therapeutic modality for the treatment of aphasia (Rao, 1994), but there is limited empirical evidence of the efficacy of gesture-based treatments. Models of the relationship between word production and gesture production have been developed (Hadar & Butterworth, 1997; Krauss & Hadar, 1999) but they are currently under-specified and provide little guidance as to whether gesture might be an efficacious treatment for word production deficits arising from particular underlying levels of impairment. Aims: This study had two main aims: First, to examine the comparative facilitation effects of gesture production and visualisation processes on object naming skills, and second, to compare the effectiveness of three types of treatment, gesture, verbal, and combined verbal plus gesture, for word production deficits arising from impairment at the level of phonological access and encoding. Methods & Procedures: A 68-year-old female, AB, participated in the study. AB sustained a single, left, frontoparietal, subarachnoid haemorrhage 6 months prior to the study, which resulted in a highly specific, mild, phonologic access and encoding impairment. AB initially participated in a trial comparing the relative effectiveness of gesture and visualisation processes for facilitating oral picture naming. A controlled multiple-baseline single-case experiment was then carried out comparing the three naming treatments. Outcomes & Results: The use of iconic gesture was found to significantly facilitate picture naming. Pointing, visualisation, and cued articulation produced negligible change from baseline rates. Clinically and statistically significant treatment effects were found for all three treatment conditions, with only marginal differences between conditions. Improvements made in picture naming were maintained at 1 and 3 month follow-up assessments and generalisation of enhanced object naming was found with novel stimuli and during spontaneous conversation. Conclusions: The results supported Krauss and Hadars (1999) model of speech and gesture production, suggesting frank interaction between the kinesic monitor of the gesture production system and the formulator of the word production system. The results caution clinicians to question the long-held axiom of the superiority of multi-modality treatments, and encourage clinicians to consider the underlying knowledge and processes generated by particular treatment protocols, rather than simply the modality in which the treatment is transmitted.

Long-term ability to interpret facial expression after traumatic brain injury and its relation to social integration

There is considerable evidence that individuals with traumatic brain injury (TBI) experience problems interpreting the emotional state of others. However, the functional implications of these changes have not been fully investigated. A study of 13 individuals with severe TBI and an equal number of matched controls found that TBI participants had significantly more difficulty interpreting facial expression and matching emotions to social situations. A significant relationship was also established between social integration and ability to interpret facial expression for TBI participants. These results support the inclusion of therapy targeting this area within rehabilitation programs for individuals with TBI.

The differential facilitatory effects of gesture and visualisation processes on object naming in aphasia

This study investigated the differential facilitation effects of gesture and visualisation processes on object naming in individuals with aphasia. Six participants with word production deficits resulting from varying levels of impairment in the word production system, underwent a series of naming trials. Baseline measures of naming were compared to those obtained following instructions to point, visualise, and produce gesture. The results supported the superiority of iconic gesture as a facilitator of object naming in aphasia. In particular, individuals with phonological access, storage, or encoding difficulties demonstrated significantly enhanced naming abilities with the use of iconic gesture as compared to individuals with a semantic impairment or an apraxia of speech. Pointing, cued articulation, and visualisation processes did not significantly enhance naming skills in these individuals. These results are discussed within the model of lexical gesture and word production proposed by Krauss and Hadar (1999).

Visual scanning in the recognition of facial affect: Is there an observer sex difference?

This investigation assessed whether differences exist in the way males and females overtly orient their visual attention to salient facial features while viewing static emotional facial expressions. Eye movements were recorded while fifty healthy participants (23 males, 27 females) viewed a series of six universal facial expressions. Groups were compared with respect to accuracy and reaction time in emotional labeling. The number and duration of foveal fixations to four predefined facial areas of interest (AOIs)--each eye, nose, mouth--were also recorded. There were no significant group differences with respect to accuracy (p = 0.997), though females were significantly faster than males in correctly identifying expressions (p = 0.047). Analysis of the visual scan path revealed that while both groups spent more time and looked more frequently at the eye region, males spent significantly more time viewing the nose and mouth. The duration and number of fixations made to the nose were significantly greater in males (p < 0.05). This study is the first to show reaction time differences between the sexes across a range of universal emotions. Further, this is the first work to suggest the orienting of attention to the lower part of the face, especially the nose, appears to differentiate the sexes.

Interpreting facial expression and communication competence following severe traumatic brain injury

Background: Facial expression is generally understood as playing a crucial role in communication, conveying both information and emotion. This study explored the nexus between the ability to interpret facial expression and communication competence for individuals with traumatic brain injury (TBI). The authors would like to thank the men and women who so generously participated in this research. We are also indebted to the staff in the Speech Pathology department at Epworth Hospital for their assistance in recruiting participants. Aims: Three research questions were addressed. The first two questions involved a comparison of TBI and control participants on perceived communication competence, and ability to interpret facial expression. The third research question addressed whether a relationship exists between ability to interpret facial expression and perceived communication competence, in individuals with TBI. Methods & Procedures: Participants included 12 individuals with severe TBI (PTA>7 days), and a group of matched controls. A measure of perceived communication competence (the La Trobe Communication Questionnaire, LCQ) and a measure related to the interpretation of facial expression (the Emotion Evaluation Test) were administered to TBI and control participants All participants nominated a “close‐other” who completed the close‐other form of the LCQ. Outcomes & Results: Results revealed that TBI participants were perceived to have significantly more difficulties with communication than control participants (p = .002). Similarly, results also revealed that TBI participants had significantly more difficulty interpreting facial expression than control participants (p<.001). Pearsons Correlation Coefficient (r) calculations demonstrated a significant relationship between ability to interpret facial expression and close‐other perception of communication competence (r = .532). Conclusions: Results are consistent with previous research, and suggest that ability to interpret facial expression is closely related to perceived communication competence, in individuals with TBI. This understanding has implications for rehabilitation and may inform the development of treatment strategies specifically targeting impairment in the ability to read facial expression.

Measuring participation after stroke: a review of frequently used tools

OBJECTIVE To identify and critique the measures currently used to assess participation in clinical stroke studies. DATA SOURCES Relevant articles published between January 2001 and April 2012 identified through Medline, CINAHL, and ProQuest Central databases. STUDY SELECTION Published articles involving poststroke assessment of participation. Case studies, cohort studies, and randomized controlled trials were included. DATA EXTRACTION The most frequently used measures were identified and the psychometric properties evaluated. Three raters independently evaluated each measure relative to the first and second coding levels of the International Classification of Functioning, Disability and Health (ICF) Activities and Participation domain categories. DATA SYNTHESIS Thirty-six measures were identified. The Stroke Impact Scale (SIS), London Handicap Scale, Assessment of Life Habits (LIFE-H), Frenchay Activities Index, and Activity Card Sort (ACS) were used most frequently. No single measure met criteria across all psychometric indices, and not one covered all 9 of the ICF Activities and Participation domains. The SIS, LIFE-H, and ACS covered the widest range. The domains covered most frequently were Community, Social and Civic Life, Domestic Life, and Mobility. Learning and Applying Knowledge, General Tasks and Demands, and Communication were the domains less frequently covered. CONCLUSIONS This review identified and evaluated the most frequently used participation measures in clinical stroke studies. The SIS, LIFE-H, and ACS covered the ICF Activities and Participation domain categories most comprehensively. However, none of the measures covered all the ICF Activities and Participation domain categories. The information provided in this systematic review can be used to guide the selection of participation measures to meet specific clinical and research purposes.

INCOG Recommendations for Management of Cognition Following Traumatic Brain Injury, Part IV: Cognitive Communication

Introduction:Cognitive-communication disorders are common in individuals with traumatic brain injury (TBI) and can have a major impact on long-term outcome. Guidelines for evidence-informed rehabilitation are needed, thus an international group of researchers and clinicians (known as INCOG) convened to develop recommendations for assessment and intervention. Methods:An expert panel met to select appropriate recommendations for assessment and treatment of cognitive-communication disorders based on available literature. To promote implementation, the team developed decision algorithms incorporating the recommendations, based on inclusion and exclusion criteria of published trials, and then prioritized recommendations for implementation and developed audit criteria to evaluate adherence to best practice recommendations. Results:Rehabilitation of individuals with cognitive-communication disorders should consider premorbid communication status; be individualized to the persons needs, goals, and skills; provide training in use of assistive technology where appropriate; include training of communication partners; and occur in context to minimize the need for generalization. Evidence supports treatment of social communication problems in a group format. Conclusion:There is strong evidence for person-centered treatment of cognitive-communication disorders and use of instructional strategies such as errorless learning, metacognitive strategy training, and group treatment. Future studies should include tests of alternative service delivery models and development of participation-level outcome measures.

Measuring Perceived Communicative Ability After Traumatic Brain Injury: Reliability and Validity of the La Trobe Communication Questionnaire*

ObjectiveFurther psychometric evaluation of a measure designed to assess communication ability after traumatic brain injury (TBI). DesignInternal consistency, test-retest reliability, and validity for self-report and close-other versions of the tool were evaluated. ParticipantsEighty-eight adults with severe TBI (mean posttraumatic amnesia 53.12 days) and 71 close others (relatives or friends). MeasureThe La Trobe Communication Questionnaire (LCQ), a 30-item questionnaire that measures cognitive-communication ability from multiple perspectives. ResultsInternal consistency coefficients were above 0.9 and test-retest reliability exceeded 0.80. The questionnaire was sensitive to the effect of severity of injury. ConclusionThe La Trobe Communication Questionnaire is a promising tool for measuring perceived communication ability in adults with severe TBI.