Jennifer P. Lundine

Dosing of a cued picture naming treatment for anomia

PURPOSE Recent investigations into effects of intensity or distribution of aphasia therapy have provided moderate evidence supporting intensive therapy schedules on aphasia treatment response. The purpose of the present study was to investigate the feasibility of creating an intensive therapy session without extending the amount of daily time a person spends in treatment. METHOD Individuals who presented with chronic anomia poststroke (N = 8) participated in 2 weeks of a computerized, therapist-delivered, cued, picture-naming treatment. Dosing parameters for each session were 8 presentations of 50 pictures, totaling 400 teaching episodes per session. RESULTS Of the 8 participants, 6 achieved significant increases from baseline on trained items after 400 teaching episodes (i.e., 1 treatment hr), and the remaining 2 participants achieved significant increases from baseline after 1200 teaching episodes (i.e., 3 treatment hr). Maintenance data from 7 of the participants indicated that 6 participants maintained significant improvement from baseline on trained items. CONCLUSIONS Given an intensive and saturated context, anomic individuals were surprisingly quick at relearning to produce problematic words successfully. Most participants demonstrated retention of the gains 2 months after treatment ended. The high density of teaching episodes within the treatment session (i.e., the intensive treatment schedule) may have contributed to the behavioral gains.

Nonverbal Working Memory as a Predictor of Anomia Treatment Success

PURPOSE The purpose of the study was to determine (a) reliability of the spatial span as a nonverbal working memory (WM) task in individuals with aphasia, (b) whether participation in anomia treatment changed spatial span scores, and (c) the degree to which visuospatial WM predicted response to anomia treatment. METHOD Eight individuals with chronic aphasia were repeatedly assessed on the forward and backward conditions of the spatial span over 4 weeks while undergoing treatment for anomia. Experiment 1 assessed reliability of the spatial span conditions and determined whether span scores changed after beginning anomia treatment. Experiment 2 investigated the spatial span as a predictor of anomia treatment success. RESULTS Results of Experiment 1 showed that 7 participants demonstrated stability of the forward condition of the spatial span, and 5 participants demonstrated stability of the backward condition across all sessions (p = .05). No participants showed an effect of aphasia treatment on span performance in either condition. Experiment 2 found that the backward span condition significantly predicted anomia treatment effect size, F(1, 6) = 15.202, p = .008. CONCLUSIONS Visuospatial WM abilities were highly predictive of response to anomia treatment, supporting an account of WM that includes a central processing mechanism.

A Tutorial on Expository Discourse: Structure, Development, and Disorders in Children and Adolescents

PURPOSE With the adoption of the Common Core State Standards, expository texts gain prominence at all grade levels and for all disciplines. Although the linguistic and cognitive complexities of exposition pose challenges for all children, they may create additional challenges for children and adolescents with language difficulties. Therefore, this tutorial provides background information for clinicians regarding the structure, development, and specific difficulties associated with exposition across the 4 modalities of listening, speaking, reading, and writing. This background is intended to help direct the attention of researchers and clinicians to needed advances in knowledge and skill if the profession is to adequately support the population of children and adolescents who struggle with language. METHOD This tutorial is based on an extensive narrative review of articles identified using a systematic search process. Cited research studies are discussed qualitatively, but intervention studies are also characterized in terms of the strength of their research designs. This method is undertaken to highlight the strengths and weaknesses of the current state of research on these topics. CONCLUSIONS Future research needs are proposed to promote discussion among researchers and to prepare clinicians for the kinds of evidence they should be demanding as a basis for their practice.

Influence of working memory on stimulus generalization in anomia treatment: A pilot study

Abstract Neuropsychological testing of distinct cognitive domains holds promise as a prognostic indicator of aphasia therapy success; however, it is unclear the degree to which cognitive assessments may also predict generalization abilities. The present study aimed to assess the relationship between working memory skills and stimulus generalization from a visual picture-naming treatment to an auditory definition-naming task. Seven individuals with aphasia completed verbal and nonverbal assessments of working memory prior to participating in a cued picture-naming treatment for anomia. After treatment ended, stimulus generalization percentages were calculated for definition naming for the same items that were trained using picture naming. Scores on two nonverbal working memory measures, the backward spatial span and the 1-back, and one verbal working memory assessment, the picture span, were positively correlated with generalization percentage. These results provide preliminary evidence of the relationship between working memory and stimulus generalization. When comparing performance across working memory measures, the spatial span and the picture span were highly correlated in this sample. We propose that despite the verbal and nonverbal distinction, these tasks may have tapped into working memory similarly by relying on a shared central processing mechanism.

Follow-up care adherence after hospital discharge in children with traumatic brain injury

Objective: To investigate factors associated with follow-up care adherence in children hospitalized because of traumatic brain injury (TBI). Design: An urban level 1 childrens hospital trauma registry was queried to identify patients (2-18 years) hospitalized with a TBI in 2013 to 2014. Chart reviewers assessed discharge summaries and follow-up instructions in 4 departments. Main Measures: Three levels of adherence—nonadherence, partial adherence, and full adherence—and their associations with care delivery, patient, and injury factors. Results: In our population, 80% were instructed to follow up within the hospital network. These children were older and had more severe TBIs than those without follow-up instructions and those referred to outside providers. Of the 352 eligible patients, 19.9% were nonadherent, 27.3% were partially adherent, and 52.8% were fully adherent. Those recommended to follow up with more than 1 department had higher odds of partial adherence over nonadherence (adjusted odds ratio [AOR] = 5.8, 95% CI: 1.9-17.9); however, these patients were less likely to be fully adherent (AOR = 0.1; 95% CI: 0.1-0.3). Privately insured patients had a higher AOR of full adherence. Conclusions: Nearly 20% of children hospitalized for TBI never returned for outpatient follow-up and 27% missed appointments. Care providers need to educate families, coordinate service provision, and promote long-term monitoring.

Referral Patterns as a Contextual Variable in Pediatric Brain Injury: A Retrospective Analysis

Purpose Access to speech-language pathology (SLP) services is a critical variable in the rehabilitation of pediatric brain injury. In this study, we examined patterns of SLP referral and factors affecting referral during the acute period following brain injury in 2 large pediatric specialty hospitals. Method In a retrospective, cohort chart review study, data collection focused on referrals made during the acute period using International Classification of Diseases, Ninth Revision, Clinical Modification codes for primary diagnoses of brain injury between 2007 and 2014 (Centers for Disease Control and Prevention [CDC], 2014). A total of 200 charts were reviewed. Data extraction included demographic and injury-related variables, referral for rehabilitation across disciplines, and plans of care following assessment. Results Samples for both facilities were similar except for primary mechanism of traumatic brain injuries and severity. SLP referral rate at Hospital 1 was 36% and only 2% at Hospital 2. Regression revealed that individuals were less likely to receive an SLP referral if injury severity was classified as unknown or mild or if they were younger in age. Conclusion SLP referral rates in the early acute period for children with brain injury were poor, creating a barrier to rehabilitation. This not only limits access to SLP services, but also may have broader and long-term impact.

Adolescent Summaries of Narrative and Expository Discourse: Differences and Predictors

Purpose Summarizing expository passages is a critical academic skill that is understudied in language research. The purpose of this study was to compare the quality of verbal summaries produced by adolescents for 3 different discourse types and to determine whether a composite measure of cognitive skill or a test of expressive syntax predicted their performance. Method Fifty adolescents listened to, and then verbally summarized, 1 narrative and 2 expository lectures (compare-contrast and cause-effect). They also participated in testing that targeted expressive syntax and 5 cognitive subdomains. Results Summary quality scores were significantly different across discourse types, with a medium effect size. Analyses revealed significantly higher summary quality scores for cause-effect than compare-contrast summaries. Although the composite cognitive measure contributed significantly to the prediction of quality scores for both types of expository summaries, the expressive syntax score only contributed significantly to the quality scores for narrative summaries. Conclusions These results support previous research indicating that type of expository discourse may impact student performance. These results also show, for the first time, that cognition may play a predictive role in determining summary quality for expository but not narrative passages in this population. In addition, despite the more complex syntax commonly associated with exposition versus narratives, an expressive syntax score was only predictive of performance on narrative summaries. These findings provide new information, questions, and directions for future research for those who study academic discourse and for professionals who must identify and manage the problems of students struggling with different types of academic discourse. Supplemental Material https://doi.org/10.23641/asha.6167879.

Incidence of aspiration in infants with single-ventricle physiology following hybrid procedure

BACKGROUND Swallowing dysfunction is a known complication for infants with complex congenital heart disease (CHD), but few studies have examined swallowing outcomes following the hybrid procedure for stage 1 palliation in children with single ventricle physiology. OBJECTIVES (1) Identify the incidence of aspiration in all infants with single ventricle physiology who underwent the hybrid procedure and (2) Compare results of clinical bedside and instrumental swallowing evaluations to examine the predictive value of a less invasive swallowing assessment for this population of high-risk infants. METHODS This was a retrospective cohort chart review study. All patients with single-ventricle physiology who underwent the hybrid procedure received a referral for subsequent instrumental swallow assessment during a 4-year period. Results from clinical bedside evaluations were compared to those of the instrumental assessment. RESULTS Fifty infants were included in this study. During instrumental swallow assessment, aspiration was observed in 28% of infants following the hybrid procedure. Normal swallowing function was identified in 44% of infants, and 28% demonstrated laryngeal penetration. Neither length of intubation nor prematurity were found to be predictors of aspiration. Thirty-six of these infants were assessed via clinical bedside evaluation prior to the instrumental evaluation. The sensitivity of the clinical bedside evaluation was 0.73 and the specificity was 0.92. CONCLUSIONS This study reports on a cohort of infants with single ventricle physiology following the hybrid procedure and found the incidence of aspiration to be lower than previously reported. Improved clinical bedside evaluation guidelines are needed so that clinicians can predict more reliably which infants are at risk for aspiration following the hybrid procedure.

The Effect of Stimulus Valence on Lexical Retrieval in Younger and Older Adults

Purpose Although there is evidence that emotional valence of stimuli impacts lexical processes, there is limited work investigating its specific impact on lexical retrieval. The current study aimed to determine the degree to which emotional valence of pictured stimuli impacts naming latencies in healthy younger and older adults. Method Eighteen healthy younger adults and 18 healthy older adults named positive, negative, and neutral images, and reaction time was measured. Results Reaction times for positive and negative images were significantly longer than reaction times for neutral images. Reaction times for positive and negative images were not significantly different. Whereas older adults demonstrated significantly longer naming latencies overall than younger adults, the discrepancy in latency with age was far greater when naming emotional pictures. Conclusions Emotional arousal of pictures appears to impact naming latency in younger and older adults. We hypothesize that the increase in naming latency for emotional stimuli is the result of a necessary disengagement of attentional resources from the emotional images prior to completion of the naming task. We propose that this process may affect older adults disproportionately due to a decline in attentional resources as part of normal aging, combined with a greater attentional preference for emotional stimuli.

Exploring Summarization Differences for Two Types of Expository Discourse in Adolescents With Traumatic Brain Injury

Purpose Annually, nearly 700,000 U.S. children and adolescents experience a traumatic brain injury (TBI). Many of them struggle academically, despite failing to qualify for special education services because their cognitive communication impairments are subtle. Method In this exploratory study, five adolescents with TBI provided verbal summaries of two expository lectures (compare-contrast, cause-effect) and participated in cognitive and expressive syntax testing. Their performance on these tasks was compared descriptively to that of 50 adolescents with typical development. Results For adolescents with TBI, mean summary quality scores for both exposition types were at least 1 SD lower than those of adolescents with typical development and notably 2 SDs below for the cause-effect passage. The adolescents with TBI who had below-average cognitive scores showed better performance on compare-contrast summaries compared to cause-effect, whereas the majority of adolescents with typical development showed the opposite tendency. Conclusions These results provide preliminary evidence that students with TBI, particularly those with cognitive deficits, may struggle with expository discourse despite acceptable performance on a measure of expressive syntax. This study also indicates that researchers should explore how students with TBI perform on academically relevant discourse tasks in order to inform future assessment and intervention efforts. Supplemental Materials https://doi.org/10.23641/asha.5572786.