Nancy Helm-Estabrooks

C-Speak Aphasia Alternative Communication Program for People with Severe Aphasia: Importance of Executive Functioning and Semantic Knowledge

Learning how to use a computer-based communication system can be challenging for people with severe aphasia even if the system is not word-based. This study explored cognitive and linguistic factors relative to how they affected individual patients ability to communicate expressively using C-Speak Aphasia (CSA), an alternative communication computer program that is primarily picture-based. Ten individuals with severe non-fluent aphasia received at least six months of training with CSA. To assess carryover of training, untrained functional communication tasks (i.e., answering autobiographical questions, describing pictures, making telephone calls, describing a short video, and two writing tasks) were repeatedly probed in two conditions: (1) using CSA in addition to natural forms of communication, and (2) using only natural forms of communication, e.g., speaking, writing, gesturing, drawing. Four of the 10 participants communicated more information on selected probe tasks using CSA than they did without the computer. Response to treatment was also examined in relation to baseline measures of non-linguistic executive function skills, pictorial semantic abilities, and auditory comprehension. Only nonlinguistic executive function skills were significantly correlated with treatment response.

Foreign accent syndrome due to conversion disorder: Phonetic analyses and clinical course

Abstract We describe the case of a 36-year-old native speaker of English who began using a foreign accent after abrupt onset of problems involving multiple sensory and motor functions. Neurological and neuroradiological examinations were within normal limits and no organic explanation for the difficulties could be identified. After eight months, the patient made a full recovery, allowing a detailed comparison between the speech patterns displayed during the period of foreign accent and those of her typical speech. Perceptual and acoustic analyses showed specific changes in vowel and consonant production and in intonation and stress patterns during the accented speech. These changes were similar to those described in the literature for patients with foreign accent syndrome following left cerebral hemisphere lesions. A review of presenting symptoms and clinical course of our case, however, indicated strong evidence for a conversion disorder. This case demonstrates that a psychogenic etiology for foreign accent syndrome should sometimes be considered and that the prognosis for recovery, including spontaneous remission, may be good in such cases. Differential diagnosis between psychogenic and neurogenic etiologies is discussed relative to the case presentation, history, course, and recovery.

Supporting autonomy for people with aphasia: Use of the life interests and values (LIV) cards

Abstract Background: People with aphasia (PWA) are frequently disregarded as reliable respondents because their language problems may restrict their responses to oral and written questioning. Consequently, family members are often asked to speak on their behalf. The Life Interests and Values (LIV) Cards are a nonlinguistic, picture-based instrument designed for communicating directly with PWA about their current and desired life activities. Purpose: The goals of this study were to (1) explore utility of LIV Cards for interviewing PWA and (2) examine congruence between responses of PWA and proxies. Method: Study participants were 10 PWA with varying language and cognitive abilities and 10 family member proxies. Both groups participated in LIV Card interviews to identify current and preferred activities of the PWA. Core interview times for the PWA and percentage of selected activities for 4 activity categories were calculated, as was item-by-item response congruency between PWA and proxies. Results: All 10 PWA completed LIV Cards interviews in 45 minutes or less. There were individualized response patterns regarding activity participation and preferences. Mean point-to-point agreement between PWA and their proxies was 74% for current activities and 71% for activity preferences of the PWA. Conclusions: PWA were able to provide information about their current and preferred involvement in life activities through use of the LIV Cards. Family members did not predict activity choices and desires of PWA with full accuracy. The LIV Cards appear to be a viable tool for setting goals and discussing life priorities of PWA.

The Pediatric Test of Brain Injury: Development and Interpretation.

The Pediatric Test of Brain Injury (PTBI) is designed to assess neurocognitive, language, and literacy abilities that are relevant to the school curriculum of children and adolescents recovering from brain injury. The PTBI is intended to help clinicians establish baseline levels of cognitive–linguistic abilities in the acute stages of recovery, identify strengths and weaknesses for informing intervention, monitor functional changes and track recovery patterns, and guide decision making related to school reintegration and educational performance. This article describes the research version of the PTBI with regard to theoretical concerns guiding its development, selection of neurocognitive and language abilities that are relevant to the school curriculum and likely to be affected by brain injury, the rationale for tracking early recovery, and research being conducted on the PTBI to establish criterion-referenced benchmarks for children and adolescents from age 6 through 16 years. Two case examples illustrate qualitative interpretations of results on each of the PTBI subtests, which are discussed with regard to implications for further curriculum-based language assessment and successful reintegration into school.