Jessica Brown

Let the games begin: A preliminary study using Attention Process Training-3 and Lumosity™ brain games to remediate attention deficits following traumatic brain injury

Abstract Primary objective: Computer-based treatments for attention problems have become increasingly popular and available. The researchers sought to determine whether improved performance by survivors of severe traumatic brain injury (TBI) on two computer-based treatments generalized to improvements on comparable, untrained tasks and ecologically-plausible attention tasks comprising a standardized assessment. Research design: The researchers used an -A-B-A-C-A treatment design repeated across four adult survivors of severe TBI. Methods and procedures: Participants engaged in 8 weeks of intervention using both Attention Process Training-3 (APT-3) and Lumosity™ (2010) Brain Games. Two participants received APT-3 treatment first, while the other two received Lumosity™ treatment first. All participants received both treatments throughout the course of two, 1-month intervention phases. Main outcomes and results: Individual growth curve analyses showed participants made significant improvements in progressing through both interventions. However, limited generalization occurred: one participant demonstrated significantly improved performance on one of five probe measures and one other participant showed improved performance on some sub-tests of the Test of Everyday Attention; no other significant generalization results emerged. These findings call into question the assumption that intervention using either APT-3 or Lumosity™ will prompt generalization beyond the actual tasks performed during treatment.

Reading experiences and use of supports by people with chronic aphasia

Background: Reading comprehension and efficiency limitations associated with chronic aphasia can negatively influence performance of essential, functional, and pleasure reading activities. Aims: The purpose of this phenomenological study was to describe the pre- and post-aphasia reading experiences of adults with chronic, acquired reading challenges and to understand the feelings and preferences of these individuals regarding various supports and strategies. Methods & Procedures: Six individuals with chronic reading comprehension deficits associated with aphasia completed written questionnaires, participated in semi-structured interviews, and were observed engaging with reading materials typical of those preferred pre- and post-aphasia. Outcomes & Results: Two major themes emerged from the data analysis: (1) changes in reading experiences post-aphasia and (2) use of supports and strategies to facilitate improved reading comprehension and efficiency. Although reading limitations prevented participants from resuming pre-aphasia occupations or reading activities, all continued to access personally relevant information through the written modality. All participants implemented supports and strategies to improve comprehension and efficiency as much as possible when performing functional reading tasks. Conclusions: Reading limitations can negatively impact life participation in functional and pleasurable activities post-aphasia. Although consistent themes appeared across participants, individualised preferences emerged regarding reading activities and use of supports and strategies.

Noun Representation in AAC Grid Displays: Visual Attention Patterns of People with Traumatic Brain Injury

Abstract Clinicians supporting the communication of people with traumatic brain injury (TBI) must determine an efficient message representation method for augmentative and alternative communication (AAC) systems. Due to the frequency with which visual deficits occur following brain injury, some adults with TBI may have difficulty locating items on AAC displays. The purpose of this study was to identify aspects of graphic supports that increase efficiency of target-specific visual searches. Nine adults with severe TBI and nine individuals without neurological conditions located targets on static grids displaying one of three message representation methods. Data collected through eye tracking technology revealed significantly more efficient target location for icon-only grids than for text-only or icon-plus-text grids for both participant groups; no significant differences emerged between participant groups.

High-context images: Comprehension of main, background, and inferential information by people with aphasia

Background: Professionals often recommend using high-context images as expressive and receptive communication supports, even though researchers know little about the information people with aphasia can extract from these images. Aims: This study’s purposes were to compare the accuracy and speed with which people with and without aphasia derive main action, background, and inferential information from high-context images. Methods & Procedures: Twenty people with and 20 people without neurological impairment selected high-context images to match spoken sentences conveying main action, background, or inferential information. Participants listened to each sentence presented twice and selected the target image from a field of four. Computation of nonparametric statistics allowed accuracy and speed comparisons between participant groups and among the three stimulus sentence conditions. Additionally, the researchers computed correlations between participants’ standardised test scores and their accuracy and speed when performing the experimental task. Outcomes & Results: Task performance by participants without aphasia was more accurate and faster than that of participants with aphasia regardless of sentence condition. Both groups were most accurate and fastest given sentences conveying main actions. The participants with aphasia were significantly slower and less accurate when selecting high-context images to match sentences relaying background and inferential information than ones relaying main action information. This pattern differed from that of participants without aphasia who demonstrated a significant decrease in accuracy only for inferential sentences; they demonstrated significantly different response speeds among all sentence conditions. No significant correlations emerged between Western Aphasia Battery-Revised Aphasia Quotient scores or Cognitive Linguistic Quick Test Executive Functioning or Visual Spatial Domain scores and participants’ accuracy or speed of experimental task performance. However, accuracy and speed in some of the sentence stimulus conditions correlated significantly with auditory comprehension subtest scores of the Comprehensive Aphasia Test. All significant correlations indicated that accuracy increased and response speed decreased as auditory comprehension scores increased. Conclusions: Participants with aphasia performed with less accuracy and were slower at responding than participants without aphasia. The fact that participants with aphasia took about twice as long to respond on average as participants without aphasia highlights the need for ample processing time when interacting with people with aphasia. However, despite their aphasia severity as measured by standardised testing, some participants performed well regardless of whether a stimulus sentence referenced main action, background, or inferential information. The results suggest that many people with aphasia can derive substantial information from high-context images.

Exploring cognitive support use and preference by college students with TBI: A mixed-methods study

PURPOSE Many college students with TBI rely on external strategies and supports to compensate for persistent memory, organization, and planning deficits that interfere with recalling and executing daily tasks. Practitioners know little, however, about the supports students with TBI choose for this purpose, the reasoning behind their choice, or preferred features of selected supports. The purpose of this study was to explore these issues. METHOD We collected and analyzed quantitative and qualitative data from eight college students with TBI for completion of a concurrent triangulation mixed-methods design. Data analysis included evaluation and triangulation of participant demographic information, survey responses about persistent post-injury symptoms, transcripts from semi-structured interviews about cognitive support devices and strategies, and ranking results about specific compensatory tools. RESULTS Results suggest that college students with TBI prefer high-tech external supports-sometimes with the addition of low-tech, paper supports-to assist them in managing daily tasks. This preference related to features of portability, accessibility, and automatic reminders. An electronic calendar was the most-preferred high-tech support, and a paper checklist was the most-preferred low-tech support. CONCLUSIONS Rehabilitation professionals should consider implementing high-tech supports with preferred characteristics during treatment given the preferences of students with TBI and the consequent likelihood of their continued long-term use following reintegration to community settings.

Preferred Visuographic Images to Support Reading by People with Chronic Aphasia

Background: Written materials used both clinically and in everyday reading tasks can contain visuographic images that vary in content and attributes. People with aphasia may benefit from visuographic images to support reading comprehension. Understanding the image type and feature preferences of individuals with aphasia is an important first step when developing guidelines for selecting reading materials that motivate and support reading comprehension. Objective: The study purposes were to determine the preferences and explore the perceptions of and opinions provided by adults with chronic aphasia regarding various image features and types on facilitating the reading process. Methods: Six adults with chronic aphasia ranked visuographic materials varying in context, engagement, and content regarding their perceived degree of helpfulness in comprehending written materials. Then, they participated in semi-structured interviews that allowed them to elaborate on their choices and convey opinions about potential benefits and detriments associated with preferred and non-preferred materials. Results/Conclusions: All participants preferred high-context photographs rather than iconic images or portraits as potential supports to facilitate reading activities. Differences in opinions emerged across participants regarding the amount of preferred content included in high context images.

Reading recovery: a case study using a multicomponent treatment for acquired alexia

Background: Individuals with acquired alexia have reading deficits that typically impede successful completion of daily activities, thus resulting in impaired functional independence. Research-based treatment approaches for acquired alexia often address single aspects underlying reading. To date, no research has explored the simultaneous presentation of several treatments or treatment including functional daily reading activities. Aims: The purpose of this study was to determine the effectiveness of a multicomponent reading intervention to increase letter recognition, grapheme-to-phoneme conversion, and single-word decoding by an individual with acquired alexia. Methods & Procedures: The study participant, JB, was an 86-year-old female 5 months postonset of a left cerebrovascular accident. JB attended 40 1-hr treatment sessions over a 5-month period. She completed five activities during each session: (a) decoding consonant-vowel-consonant (CVC) words; (b) performing grapheme-to-phoneme activities requiring letter recognition, naming, and associated phoneme production; (c) engaging in repeated and choral reading tasks; (d) performing modified Anagram and Copy Treatment and Copy and Recall tasks; and (e) engaging in reading of functional materials. Outcomes & Results: Intervention was effective in enhancing JB’s letter identification, grapheme-to-phoneme conversion, and single-word decoding skills. Decoding of CVC words, phonological awareness, and functional reading skills improved steadily over the treatment period. Conclusions: The participant progressed from meeting criteria for global alexia to displaying behaviours more consistent with pure alexia. By the conclusion of treatment, she accurately identified most graphemes and produced corresponding phonemes for letter-by-letter and phonological single-word decoding; in the home setting, she attempted to read and write independently, requested assistance with reading when necessary, and independently attended to pictorial cues presented with reading materials.

Comprehension of synthetic speech and digitized natural speech by adults with aphasia

Using text-to-speech technology to provide simultaneous written and auditory content presentation may help compensate for chronic reading challenges if people with aphasia can understand synthetic speech output; however, inherent auditory comprehension challenges experienced by people with aphasia may make understanding synthetic speech difficult. This studys purpose was to compare the preferences and auditory comprehension accuracy of people with aphasia when listening to sentences generated with digitized natural speech, Alex synthetic speech (i.e., Macintosh platform), or David synthetic speech (i.e., Windows platform). The methodology required each of 20 participants with aphasia to select one of four images corresponding in meaning to each of 60 sentences comprising three stimulus sets. Results revealed significantly better accuracy given digitized natural speech than either synthetic speech option; however, individual participant performance analyses revealed three patterns: (a) comparable accuracy regardless of speech condition for 30% of participants, (b) comparable accuracy between digitized natural speech and one, but not both, synthetic speech option for 45% of participants, and (c) greater accuracy with digitized natural speech than with either synthetic speech option for remaining participants. Ranking and Likert-scale rating data revealed a preference for digitized natural speech and David synthetic speech over Alex synthetic speech. Results suggest many individuals with aphasia can comprehend synthetic speech options available on popular operating systems. Further examination of synthetic speech use to support reading comprehension through text-to-speech technology is thus warranted.

Use of Visual Cues by Adults With Traumatic Brain Injuries to Interpret Explicit and Inferential Information.

Objective:Concomitant visual and cognitive impairments following traumatic brain injuries (TBIs) may be problematic when the visual modality serves as a primary source for receiving information. Further difficulties comprehending visual information may occur when interpretation requires processing inferential rather than explicit content. The purpose of this study was to compare the accuracy with which people with and without severe TBI interpreted information in contextually rich drawings. Participants:Fifteen adults with and 15 adults without severe TBI. Design:Repeated-measures between-groups design. Main Measures:Participants were asked to match images to sentences that either conveyed explicit (ie, main action or background) or inferential (ie, physical or mental inference) information. The researchers compared accuracy between participant groups and among stimulus conditions. Results:Participants with TBI demonstrated significantly poorer accuracy than participants without TBI extracting information from images. In addition, participants with TBI demonstrated significantly higher response accuracy when interpreting explicit rather than inferential information; however, no significant difference emerged between sentences referencing main action versus background information or sentences providing physical versus mental inference information for this participant group. Conclusions:Difficulties gaining information from visual environmental cues may arise for people with TBI given their difficulties interpreting inferential content presented through the visual modality.

Consistency and idiosyncrasy of semantic categorization by individuals with traumatic brain injuries

Abstract Purpose: Information about semantic categorization consistency may help practitioners to implement augmentative and alternative communication (AAC) options for people with traumatic brain injuries (TBIs). The researchers sought to determine the consistency and extent of general consensus agreement with which adults with TBI organize semantic information. Methods: The researchers compared the semantic categorization consistency of 10 participants with severe TBI to 10 neurotypical adults matched on age and gender. Participants performed a semantic categorization task three times over a 1-month period. The experimental task consisted of two stages: (a) sorting ordinate exemplars into superordinate categories and (b) sorting subordinate exemplars into the previously established ordinate categories. Results: Results showed that participants with TBI were less consistent across trials and more idiosyncratic than neurotypical peers in placing exemplars within categories. Although some participants with TBI achieved higher general consensus agreement scores with experimental task repetition, their performance did not reach levels comparable to those of neurotypical participants. Conclusions: Individually, semantic categorization patterns of some people with severe TBI conform to those of neurotypical adults; patterns of others do not. Some, but not all, survivors demonstrate increased consistency given task repetition. These findings have implications for AAC design and instruction for people with TBI. Implications for Rehabilitation Clinicians should evaluate the manner in which an individual with TBI categorizes semantic information rather than assuming that he/she intuitively uses the hierarchical superordinate–ordinate–subordinate categorization pattern common to neurotypical adults. Clinicians should evaluate the consistency with which an individual with TBI categorizes semantic information before determining the manner of organizing content within an AAC system or device. When individuals with TBI display idiosyncratic and/or inconsistent patterns of semantic organization, clinicians should explore the possibility that repeated exposure to specific lexical items or direct instruction about categorization strategies will normalize and/or stabilize performance.