Neila J. Donovan

Conceptualizing functional cognition in stroke.

Background. Up to 65% of individuals demonstrate poststroke cognitive impairments, which may increase hospital stay and caregiver burden. Randomized stroke clinical trials have emphasized physical recovery over cognition. Neuropsychological assessments have had limited utility in randomized clinical trials. These issues accentuate the need for a measure of functional cognition (the ability to accomplish everyday activities that rely on cognitive abilities, such as locating keys, conveying information, or planning activities). Objective. The aim of the study was to present the process used to establish domains of functional cognition for development of computer adaptive measure of functional cognition for stroke. Methods. Functional cognitive domains involved in identifying relevant neuropsychological constructs from the literature were conceptualized and finalized after advisory panel feedback from experts in neurology, neuropsychology, aphasiology, clinical trials, and epidemiology. Results. The following 17 domains were proposed: receptive aphasia, expressive aphasia, agraphia, alexia, calculation, visuospatial, visuoperceptual, visuoconstruction, attention, language usage, executive functions, orientation, processing speed, memory, working memory, mood, awareness and abstract reasoning. The advisory panel recommended retaining the first 12 domains. Recommended changes included: to address only encoding and retrieval of recent information in the memory domain; to add domains for limb apraxia and poststroke depression; and to keep orientation as a separate domain or reclassify it under memory or attention. The final 10 domains included: language, reading and writing, numeric/calculation, limb praxis, visuospatial function, social use of language, emotional function, attention, executive function, and memory. Conclusion. Conceptualizing domains of functional cognition is the first step in developing a computer adaptive measure of functional cognition for stroke. Additional steps include developing, refining, and field-testing items, psychometric analysis, and computer adaptive test programming.

The item level psychometrics of the behaviour rating inventory of executive function-adult (BRIEF-A) in a TBI sample

Primary objective: To determine whether the psychometrics of the BRIEF-A are adequate for individuals diagnosed with TBI. Research design: A prospective observational study in which the BRIEF-A was collected as part of a larger study. Methods and procedures: Informant ratings of the 75-item BRIEF-A on 89 individuals diagnosed with TBI were examined to determine items level psychometrics for each of the two BRIEF-A indexes: Behaviour Rating Index (BRI) and Metacognitive Index (MI). Patients were either outpatients or at least 1 year post-injury. Main outcomes and results: Each index measured a latent trait, separating individuals into five-to-six ability levels and demonstrated good reliability (0.94 and 0.96). Four items were identified that did not meet the infit criteria. Conclusions: The results provide support for the use of the BRIEF-A as a supplemental assessment of executive function in TBI populations. However, further validation is needed with other measures of executive function. Recommendations include use of the index scores over the Global Executive Composite score and use of the difficulty hierarchy for setting therapy goals.

Item Response Theory Analysis of the Western Aphasia Battery

Background: The Western Aphasia Battery (WAB) (Kertesz, 1982) is one of the most frequently used tests of general language performance in aphasia, despite significant psychometric limitations. Item response theory (IRT) provides measurement models that may address some of these limitations. Aims: The purposes of this investigation were to evaluate whether the WAB can be productively fit to an IRT model, and to evaluate whether IRT modelling confers psychometric benefits. Methods & Procedures: An analysis of WAB data collected from a convenience sample of 101 individuals with chronic aphasia was undertaken. Exploratory factor analysis was conducted to evaluate the dimensionality of the WAB, and a Rasch Partial Credit Model was fit to the data. Item fit statistics and residual correlations were used to test key model assumptions. The distribution of traditional and Rasch-based person scores, and the relationship between ability level and test reliability were also examined. Outcomes & Results: Despite reasonable overall fit to the model, a small number of WAB items demonstrated significant misfit, suggesting that they do not productively contribute to the measurement of aphasia severity. A small but substantial minority of individuals also demonstrated inadequate fit to the measurement model. Rasch-based scores were more normally distributed than traditional scores, and score reliability varied substantially across the ability range. Conclusions: These results suggest that the WAB may be productively fit to an IRT-based measurement model, and that such models may be used to improve the psychometric properties of aphasia tests. Benefits include indices of severity and score reliability that are more valid than those currently in use, and the potential for improved efficiency of testing through adaptive administration.

Dysphagia with Bilateral Lesions of the Insular Cortex

It has been demonstrated that the insular cortex plays an important role in the swallowing mechanism. This case report describes a patient with bilateral insular cortex lesions and dysphagia secondary to viral meningitis. Recent evaluations of the insula’s role in the swallowing mechanism are discussed.

Conceptualizing functional cognition in traumatic brain injury rehabilitation

Primary objective: To conceptualize functional cognitive constructs across the continuum of traumatic brain injury (TBI) recovery, to form the foundation for the Computer Adaptive Measure of Functional Cognition for TBI (CAMFC-TBI). Background: TBI often has a profound impact on a survivors ability to return to previous level of functioning and significantly reduces the overall quality of life for survivors and caregivers. Few assessments are designed to evaluate TBIs impact on cognitive functioning in everyday life. Neuropsychological tests are time consuming and may have questionable ecological validity for predicting functional outcomes. Global functional assessments contain few cognitive items and may lack psychometric rigour. Presently there is a lack of efficient, precise, ecologically valid functional cognitive measures. Main outcome and results: Studies that used neuropsychological and global functional assessments were reviewed to direct conceptualization of functional cognitive constructs across TBI recovery stages. An advisory panel reviewed study methodology and functional cognitive constructs development. They validated the need for the CAMFC-TBI and the six functional cognitive constructs: attention, memory, processing speed, executive functioning, social communication and emotional management. Conclusion: Conceptualizing functional cognitive constructs is the first step in CAMFC-TBI development. Future project stages include item pool development, qualitative testing, field-testing, psychometric analysis and computerized adaptive test programming.

Preliminary results from conversation therapy in two cases of Aphasia

Background: Few studies have investigated conversation therapy between a person with aphasia and a clinician. Furthermore, little information exists on generalisation of impairment-based stimulation treatment to conversational outcomes. Aim: The purpose of this preliminary study was to compare the effects of stimulation therapy and conversation therapy on conversational outcome measures in two cases. Method: We employed a single-subject AB1AB2A design with randomised ordering of interventions across two participants. Primary outcomes included 6-minute conversations coded for discourse functions of an utterance. Outcomes & Results: The participant who received stimulation therapy first demonstrated improved conversational outcomes after the first phase. The participant who received conversation therapy first demonstrated improved conversational outcomes after the first phase. Although improvements were made in each type of therapy, the highest gains in conversational production were during or following conversation therapy in either treatment order for both participants. Conclusion: Both types of therapy produced gains in conversational abilities. However, the small number of participants limits the generalisability of this study. Future research is needed to determine which participants may benefit most from conversation therapy and to improve the clinical feasibility of conducting and measuring conversational therapy.

Why Consider Impaired Social Language Usage in a Case of Corticobasal Degeneration

The purpose of this case study was to examine the integrity of cognitive skills, language usage, and language structure components in a patient with corticobasal degeneration (CBD). CBD is a levadopa-nonresponsive, degenerative neurologic movement disorder that is generally accompanied by cognitive (frontal executive dysfunction, dementia) and linguistic (aphasia) disorders. However, no one has reported on social language usage deficits in cases of CBD. The reported frontal executive dysfunction found in CBD led us to expect social language usage deficits in the present case study. Consistent with the literature, the patient demonstrated motor, cognitive (severe apraxia, frontal executive deficits, dementia), and linguistic deficits (aphasia). However she also demonstrated significantly abnormal social language usage previously unreported in the literature.

Research applications for An Object and Action Naming Battery to assess naming skills in adult Spanish–English bilingual speakers

Virtually no valid materials are available to evaluate confrontation naming in Spanish–English bilingual adults in the U.S. In a recent study, a large group of young Spanish–English bilingual adults were evaluated on An Object and Action Naming Battery (Edmonds & Donovan in Journal of Speech, Language, and Hearing Research 55:359–381, 2012). Rasch analyses of the responses resulted in evidence for the content and construct validity of the retained items. However, the scope of that study did not allow for extensive examination of individual item characteristics, group analyses of participants, or the provision of testing and scoring materials or raw data, thereby limiting the ability of researchers to administer the test to Spanish–English bilinguals and to score the items with confidence. In this study, we present the in-depth information described above on the basis of further analyses, including (1) online searchable spreadsheets with extensive empirical (e.g., accuracy and name agreeability) and psycholinguistic item statistics; (2) answer sheets and instructions for scoring and interpreting the responses to the Rasch items; (3) tables of alternative correct responses for English and Spanish; (4) ability strata determined for all naming conditions (English and Spanish nouns and verbs); and (5) comparisons of accuracy across proficiency groups (i.e., Spanish dominant, English dominant, and balanced). These data indicate that the Rasch items from An Object and Action Naming Battery are valid and sensitive for the evaluation of naming in young Spanish–English bilingual adults. Additional information based on participant responses for all of the items on the battery can provide researchers with valuable information to aid in stimulus development and response interpretation for experimental studies in this population.

Using Rasch analysis to examine the item-level psychometrics of the Infant-Toddler Meaningful Auditory Integration Scales

The Infant-Toddler Meaningful Auditory Integration Scales (IT-MAIS; Zimmerman-Phillips, S., Osberger, M.J., Robbins, A.M. 2001. Infant-toddler meaningful auditory integration scale. Sylmar, CA: Advanced Bionics Corporation) is a popular assessment designed to measure listening skills in children with hearing loss aged 0–3 years. For this study we analyzed the item-level psychometric properties of the IT-MAIS via Rasch analysis to gain further understanding about its validity and reliability. We chose to analyze the psychometric properties of the IT-MAIS because very little information exists regarding its development and validation, although it is widely used to assess listening skills in children with sensorineural hearing loss ages 0–3 years pre- and post-cochlear implant (CI). Our results indicated that the IT-MAIS items demonstrated less than ideal psychometric properties and the IT-MAIS item order did not reflect the order in which children are expected to develop functional listening skills. Our findings suggest that there is a pressing need for further discussion among researchers and clinicians about (1) how the IT-MAIS is used, and (2) what other valid and reliable outcome measures could be used alongside, or in place of, the IT-MAIS to determine CI candidacy, establish treatment goals, or track progress in listening development in very young children with hearing loss.

Effect of time of day on language in healthy ageing and Alzheimer's disease.

AIM To investigate whether narrative discourse followed a diurnal pattern across one ten-hour day in healthy ageing people and those with mild to moderate Alzheimers disease (AD). METHOD Ten healthy ageing people and ten clinically labelled with probable AD were recruited. Measurements of language and cognition were collected across one day at 9am, 12pm, 3pm and 6pm. Language samples were evaluated for quantity (total utterances and words per minute) and quality: mazes or fillers, repetitions and revisions, abandoned utterances and type token ratio or percentage of different words to total words. RESULTS The healthy ageing group performed significantly better on cognitive measures across the day than the AD group. At all times the healthy ageing group produced significantly longer narrative samples that were significantly less aborted and revised than the AD group. Additionally, both groups demonstrated declining narrative performance as the day progressed. CONCLUSION Based on these results, time of day may be an additional factor that moderates narrative performance. This change in narrative ability may have an effect on making a proper diagnosis, therapeutic effectiveness and patient interactions, therefore affecting quality of care.