Monica Strauss Hough

Narrative comprehension in adults with right and left hemisphere brain-damage: Theme organization

The effects of delayed presentation of a central theme on the comprehension and interpretation of narratives were investigated in adults with right and left hemisphere brain-damage and normal individuals. The performance of subgroups of the subjects with right and left hemisphere brain-damage also was examined. Right hemisphere brain-damaged groups with anterior and posterior lesions were significantly less accurate and identified significantly fewer central themes when central theme presentation was delayed until the end of a narrative than when the theme was presented at the beginning. Subjects with anterior right hemisphere brain-damage produced significantly more embellishments and confabulations than subjects with posterior damage and non-brain-damaged controls, regardless of theme condition. The performance of non-brain-damaged subjects and subjects with fluent and nonfluent aphasia was unaffected by the organization of the central theme in the narratives.

Functional Communication in Individuals with Chronic Severe Aphasia Using Augmentative Communication

Intervention incorporating augmentative and alternative communication (AAC) is often implemented with adults with aphasia, although studies do not always specify the approaches and strategies used. This study examined abilities of three individuals with chronic non-fluent aphasia (NA) using a dynamic display AAC device to enhance communication. The device, Dialect with Speaking Dynamically Pro, was tailored to each participants skill level using a treatment protocol adapted from Koul, Corwin, and Hayes (). The primary caregiver was the spouse. Pre and post-treatment measures revealed improvement in quality and effectiveness of communication for all participants. Improved linguistic and cognitive functioning was observed for two participants. Results are discussed relative to use of a device with other adults with chronic NA.

Descriptive discourse abilities of traumatic brain-injured adults

Background: Studies examining the discourse abilities of adults who have suffered traumatic brain injuries (TBI) have revealed that although these individuals display relatively normal language skills on traditional aphasia tests, they demonstrate varying levels of impairment in the coherence, cohesion, and informational content of their extended verbal output. Discourse studies with the TBI population have varied relative to the type of discourse task as well as the level or approach of analysis. One approach to discourse analysis has involved examination of the cognitive functions distinguishing macrostructural and microstructural discourse processing. Macrostructural analyses are global analyses focused at the level of the entire text, dealing with large supra-sentential discourse units. Microstructural analyses are concerned with smaller structural elements in a text and the relations between these elements; the focus is at the local level of the word or sentence. Aims: In the current investigation, three analyses were undertaken to examine descriptive discourse production of five high-functioning TBI adults (three males, two females) who had suffered brain injury as the result of motor vehicle accidents. The first analysis, thematic coherence, is a macrostructural analysis, whereas the other two analyses, cohesion and lexical errors, are microstructural analyses. Methods & Procedures: Two topics, family description and work experience, were used to elicit discourse; performance was compared between the language samples. Each participants performance was reviewed individually and findings were compared to the mean performance of a group of 15 normal functioning young adults. For thematic coherence, global and local coherence were evaluated and scored separately on different 5-point rating scales. Cohesion analysis involved identification of three types of cohesive ties (closed-class appropriate, open-class appropriate, incomplete cohesion) with scores computed as proportions of total spoken words. Lexical error production included identification of verbal paraphasias and indefinite terms, also computed as proportions of total words spoken. Outcomes & Results: The results revealed that mean coherence ratings for each TBI participant were consistently lower than those observed for the control group, regardless of coherence type (local, global) or discourse topic (family, work). Furthermore, the TBI participants demonstrated greater difficulty with global than local coherence and showed more performance variability among participants in global as compared to local coherence. However, all five TBI adults displayed minimal deficits in lexical production and cohesion. Conclusions: Overall, the findings revealed dissociation of microlinguistic and macrolinguistic cognitive functions in the TBI participants, thus providing support for the distinction between and independent organisation of microstructural and macrostructural discourse components.

Mild traumatic brain injury: Effects on naming in word retrieval and discourse

Primary objective: To investigate differences between a group with mild traumatic brain injury (MTBI) and a control group relative to standard scores and error type during word retrieval in both naming and discourse tasks. Methods and procedures: Ten participants with MTBI were age-, gender- and education-matched with 10 participants without injury. Pre-experimental tasks for the participants with MTBI included the Scales of Cognitive Ability for Traumatic Brain Injuryand the Ravens Coloured Progressive Matricesand both groups received the Peabody Picture Vocabulary Test-III. Experimental tasks included the Test of Adolescent/Adult Word Findingand the Test of Word Finding in Discourse. Main outcomes and results: Few participants (three on each experimental task) demonstrated psychometrically-based word retrieval deficits (standard score < 85); however, a significant difference in performance for the TAWFas compared to the TWFDwas observed between groups. More word finding errors occurred with confrontational naming than with discourse tasks for both groups, with latency as the primary error type. Conclusions: Confrontational naming tasks may be more sensitive to subtle language difficulties occurring after MTBI. The study of adults with MTBI and their performance on semantically-based tasks offers important information for the advancement of therapeutic intervention and education.

Use of AAC to enhance linguistic communication skills in an adult with chronic severe aphasia

Background: Individuals with non‐fluent aphasia (NA) exhibit sparse verbal output and impaired word‐finding skills. For some, traditional speech‐language therapy aids in regaining verbal communication. For other aphasic individuals these techniques are unsuccessful. Augmentative and alternative communication (AAC) provides a means of communicating through devices/techniques when spoken skills are not adequate. Individuals with chronic NA can use AAC to communicate; however, many investigations do not include strategies to facilitate communication or caregiver participation. Also, variables influencing treatment efficiency (length, intensity) have not been sufficiently evaluated. Aims: The current study expanded on Johnson, Hough, King, Vos, and Jeffs (2008), investigating if a gentleman with severe, chronic NA could learn to use an AAC device, monitoring communication skill improvement periodically throughout treatment. Methods & Procedures: TE, a 56‐year‐old left‐handed, Caucasian male with severe NA and apraxia of speech resulting from left CVA participated. The Western Aphasia Battery‐Revised and ASHA FACS were administered pre‐treatment, at 1 and 2 months, and post‐treatment. The American Speech‐Language Hearing Association Quality of Communication Life Scale and Communicative Effectiveness Index were administered pre‐ and post‐treatment. The AAC device used was Dialect by Zygo with Speaking Dynamically Pro. The treatment protocol was similar to Koul, Corwin, and Hayes (2005) and Johnson et al. (2008). Treatment was 1 hour, 4 days weekly, over 3 months. The first stage, four‐level symbol identification, organised a hierarchical structure in which TE was to identify each symbol on the display. The second stage involved navigation to category, choosing a symbol requested by the clinician, which evolved into scenario role‐play; TE was asked questions about life situations and daily schedules. The next phase, sentences, involved answering questions about everyday activities/interests with short phrases using symbols. The spouse received training that included overview on navigating symbol levels, hierarchy structure used with symbols, facilitation strategies, and cues/prompts to incorporate device use outside therapy. Outcomes & Results: Results revealed that TE performed all stages of the treatment programme, allowing progression to each phase of treatment. He completed the programme in 40 therapy sessions. WAB scores (AQ, CQ) showed that performance continually improved on both scores throughout the entire protocol, with most increases in the last month. ASHA FACS scale ratings also yielded continuous increases throughout the regimen for all communication scales. Conclusions: Findings support previous research indicating that individuals with chronic NA can learn symbol‐meaning association using AAC. Implementation of a device should be a viable consideration for chronic, severe NA.

Can within-category naming identify subtle cognitive deficits in the mild traumatic brain-injured patient?

BACKGROUND This investigation examined the effect of a speeded, computer-controlled task on detecting differences in latency and accuracy of within-category name generation in adults having sustained a mild traumatic brain injury (MTBI). METHODS Twenty-four adults in acute recovery and 24 age-matched controls were instructed to view 72 pictures on a computer monitor, and then name another item belonging to the same category as the visual stimulus as quickly as possible. RESULTS The MTBI group demonstrated significantly longer latencies (p < 0.001) and lower accuracy (p < 0.001) than the control group. Both groups displayed similar patterns of response, although the MTBI group produced significantly more perseverative errors (p < 0.001). No significant correlations were found between performance on the Scales of Cognitive Ability for Traumatic Brain Injury and response latency or accuracy. CONCLUSION The MTBI group performed the task significantly slower and less accurately than controls. Reaction time measures may prove more sensitive than traditional assessment measures in detecting subtle difficulties.

The effects of self-generated synchronous and asynchronous visual speech feedback on overt stuttering frequency

PURPOSE Relatively recent research documents that visual choral speech, which represents an externally generated form of synchronous visual speech feedback, significantly enhanced fluency in those who stutter. As a consequence, it was hypothesized that self-generated synchronous and asynchronous visual speech feedback would likewise enhance fluency. Therefore, the purpose of this study was to investigate the effects of self-generated visual feedback (i.e., synchronous speech feedback with a mirror and asynchronous speech feedback via delayed visual feedback) on overt stuttering frequency in those who stutter. METHOD Eight people who stutter (4 males, 4 females), ranging from 18 to 42 years of age participated in this study. Due to the nature of visual speech feedback, the speaking task required that participants recite memorized phrases in control and experimental speaking conditions so that visual attention could be focused on the speech feedback, rather than a written passage. During experimental conditions, participants recited memorized phrases while simultaneously focusing on the movement of their lips, mouth, and jaw within their own synchronous (i.e., mirror) and asynchronous (i.e., delayed video signal) visual speech feedback. RESULTS Results indicated that the self-generated visual feedback speaking conditions significantly decreased stuttering frequency (Greenhouse-Geisser p=.000); post hoc orthogonal comparisons revealed no significant differences in stuttering frequency reduction between the synchronous and asynchronous visual feedback speaking conditions (p=.2554). CONCLUSIONS These data suggest that synchronous and asynchronous self-generated visual speech feedback is associated with significant reductions in overt stuttering frequency. Study results were discussed relative to existing theoretical models of fluency-enhancement via speech feedback, such as the engagement of mirror neuron networks, the EXPLAN model, and the Dual Premotor System Hypothesis. Further research in the area of self-generated visual speech feedback, as well as theoretical constructs accounting for how exposure to a multi-sensory speech feedback enhances fluency, is warranted. LEARNING OUTCOMES : Readers will be able to (1) discuss the multi-sensory nature of fluency-enhancing speech feedback, (2) compare and contrast synchronous and asynchronous self-generated and externally generated visual speech feedback, and (3) compare and contrast self-generated and externally generated visual speech feedback.

The Effect of an Effortful Swallow on the Normal Adult Esophagus

The effect of an effortful swallow on the healthy adult esophagus was investigated using concurrent oral and esophageal manometry (water perfusion system) on ten normal adults (5 males and 5 females, 20–35 years old) while swallowing 5-ml boluses of water. The effects of gender, swallow condition (effortful versus noneffortful swallows), and sensor site within the oral cavity, esophageal body, and lower esophageal sphincter (LES) were examined relative to amplitude, duration, and velocity of esophageal body contractions, LES residual pressure, and LES relaxation duration. The results of this study provide novel evidence that an effortful oropharyngeal swallow has an effect on the esophageal phase of swallowing. Specifically, effortful swallowing resulted in significantly increased peristaltic amplitudes within the distal smooth muscle region of the esophagus, without affecting the more proximal regions containing striated muscle fibers. The findings pertaining to the LES are inconclusive and require further exploration using methods that permit more reliable measurements of LES function. The results of this study hold tremendous clinical potential for esophageal disorders that result in abnormally low peristaltic pressures in the distal esophageal body, such as achalasia, scleroderma, and ineffective esophageal motility. However, additional studies are necessary to both replicate and extend the present findings, preferably using a solid-state manometric system in conjunction with bolus flow testing on both normal and disordered populations, to fully characterize the effects of an effortful swallow on the esophagus.

Jobs, Sex, Love and Lifestyle: When Nonstutterers Assume the Roles of Stutterers

Purpose: This study assessed the impact of stuttering via a questionnaire in which fluent individuals were asked to assume the mindset of persons who stutter (PWS) in various life aspects, including vocation, romance, daily activities, friends/social life, family and general lifestyle. The perceived impact of stuttering through the mind’s eyes of nonstutterers is supposed to reflect respondents’ abilities to impart ‘theory of mind’ in addressing social penalties related to stuttering. Method: Ninety-one university students answered a questionnaire containing 56 statements on a 7-point Likert scale. Forty-four participants (mean age = 20.4, SD = 4.4) were randomly selected to assume a stuttering identity and 47 respondents (mean age = 20.5, SD = 3.1) to assume their normally fluent identity. Results: Significant differences between groups were found in more than two thirds of items regarding employment, romance, and daily activities, and in fewer than half of items regarding family, friend/social life, and general life style (p <0.001). Conclusions: The social penalties associated with stuttering appear to be apparent to fluent individuals, especially in areas of vocation, romance, and daily activities, suggesting that nonstuttering individuals, when assuming the role of PWS, are capable of at least temporarily feeling the negative impact of stuttering.

Incidence of Word Finding Deficits in Normal Aging

The incidence and pattern of word finding deficits was investigated in a group of 50 non-neurologically-impaired older adults, ranging in age from 54 to 75. The Test of Adolescent/Adult Word Finding (TAWF; German, 1990) was administered to all individuals. Overall, 28% of the adults exhibited abnormal word finding standard scores on the TAWF. Specifically, 3 word finding profiles were observed: (1) normal psychometric scores and normal word retrieval performance across all subtests; (2) normal psychometric performance with selective impairment on picture naming of nouns, and (3) abnormal word finding standard scores with impaired performance on more than 1 subtest, which included picture naming of nouns as well as category naming. The most frequently occurring error type on picture naming of nouns was productions that were semantically related to the target. The results are discussed relative to the representation of information in semantic memory and its interaction with the lexicon.The incidence and pattern of word finding deficits was investigated in a group of 50 non-neurologically-impaired older adults, ranging in age from 54 to 75. The Test of Adolescent/Adult Word Finding (TAWF; German, 1990) was administered to all individuals. Overall, 28% of the adults exhibited abnormal word finding standard scores on the TAWF. Specifically, 3 word finding profiles were observed: (1) normal psychometric scores and normal word retrieval performance across all subtests; (2) normal psychometric performance with selective impairment on picture naming of nouns, and (3) abnormal word finding standard scores with impaired performance on more than 1 subtest, which included picture naming of nouns as well as category naming. The most frequently occurring error type on picture naming of nouns was productions that were semantically related to the target. The results are discussed relative to the representation of information in semantic memory and its interaction with the lexicon. Copyright