Nidhi Mahendra

fMRI variability and the localization of languages in the bilingual brain.

The cerebral localization of multiple languages is a topic of active research. This study presents a method for assessing whether partial overlap of active voxels reflects differential language localization, or simply the variability known to occur with multiple runs of the same task in fMRI studies. Two groups of bilingual subjects (early and later learners of L2) performed word fluency and sentence generation tasks in both languages. The degree of separation for regions of activation did not exceed that associated with run-to-run variability for either task or either group. Early bilinguals, however, showed greater total numbers of active voxels than Late bilinguals for both tasks. This effect occurred despite a lack of a behavioral performance differences by the two groups.

Insight in Alzheimer's patients: Results of a longitudinal study using three assessment methods

Three direct measures of dementia insight were administered to 20 participants in a longitudinal Alzheimers disease (AD) rehabilitation research project 1 and to subsets of these participants that completed one (N = 19), two (N = 12), and three (N = 6) years of program participation. The measures were: (1) responses to a discourse prompt question about AD (ADPQ); (2) endorsements of seven items on the Geriatric Depression Scale 2 (GDS) about the effects of dementia (separate analyses were done for two of the seven items that related specifically to memory and thinking); and (3) a sentence-completion exercise. Responses to measures 1 and 2 and the subset of 2 were quantified, tracked over time, and subjected to correlational analyses with age, Mini-Mental State Exam 3 (MMSE) score, and depression, as measured by total GDS score, and with each other. Major findings: There were no decreases in insight from baseline to year 1, 2, or 3, as measured by free responses to the AD prompt question. There was a significant decline in insight from baseline to year one on the GDS measure, but no change from year 1 to year 2 and a return to baseline level at year 3. There was no correlation between insight and baseline age, between insight and MMSE score at any time point, between MMSE score and depression, as measured by total GDS score, or between MMSE score and depression score, except for the year 3 completers, where depression score was negatively correlated with MMSE score at year 3 only. GDS insight and ADPQ scores were not correlated. Several participants that showed no insight on the quantified measures did so on the sentence completions.

Effects of Four Years of Exercise, Language, and Social Interventions on Alzheimer Discourse.

UNLABELLED This article describes a comprehensive cognitive-linguistic intervention program for mild to moderate Alzheimers disease (AD) patients that provided communication skills practice in the context of health-enhancing and esteem-building community-based activities: physical fitness training and supervised volunteer work. The interventions were administered by undergraduate students who completed academic work, received faculty supervision, and earned three credits for one semester of participation. Effects of the interventions on the discourse of four participants who completed all 4 years of the program are reported in detail. The maintained or improved performance on multiple discourse outcome measures provides powerful rationale for making such interventions more widely available and preliminary support for their effectiveness in preserving communicative function. An additional role for speech-language pathologists (SLPs)--as trainers and supervisors of non-professional rehab partners for persons with dementia--is proposed. LEARNING OUTCOMES From this article, participants will be able to (1) list specific language tasks that can be used to assess discourse in individuals with AD; (2) identify several cognitive-linguistic interventions appropriate for use with AD patients; and (3) understand how long-term cognitive-linguistic interventions may affect the language performance of individuals with AD.

Communication abilities of individuals with late-stage Alzheimer disease.

The communication abilities of 49 individuals in the late stage of Alzheimer disease were examined in relation to other markers of late-stage Alzheimer disease (e.g., incontinence and ambulatory ability). Two existing tools used to stage severity of dementia, the Global Deterioration Scale and the Functional Assessment Stages, have represented communication abilities in individuals with late-stage Alzheimer disease to be minimal to nonexistent. The individuals in this sample showed greater communication skills and verbal output than would be predicted by these scales.

Individuals with Alzheimer's disease achieve implicit and explicit learning: Previous success replicated with different stimuli

Background: This study is a replication and extension of a verbal learning experiment reported in this journal (Arkin, Rose, & Hopper, 2000) with individuals who had Alzheimers disease (AD). Those participants demonstrated implicit and explicit learning of exemplars from an inanimate semantic category (items people wear). Aims: The purpose of this study was to examine the effects of repeated exposure to animal exemplars on implicit and explicit learning of 13 individuals with mild to moderate dementia due to AD (of which 7 also participated in the earlier study). Methods and Procedures: Following 18–20 60‐second baseline fluency tests of the target category “animals”, participants engaged in eight sessions of a picture naming and related quiz exercise (study task) that contained 34 words from the target category (exposure words). One hour after each study task session, the fluency test used at baseline was re‐administered (experimental fluency test (EFT)). Outcomes and Results: On the study task, the group achieved a significant improvement in the number of correct answers from the first to their best and to their eighth trial (evidence of explicit learning). On the EFTs, 10 of the 13 AD participants produced one or more exposure words never named during the baseline fluency tests (evidence of implicit learning), and 12 out of 13 participants produced novel words that were not exposure words and not produced at baseline (evidence of spreading activation). Additionally, the explicit learning performance of the seven individuals who participated in our earlier study and in this study were compared for the “items people wear” (nonliving) and “animals” (living) categories. This comparison revealed a significantly greater improvement in naming performance from the first to the best study task trials for the “items people wear” (nonliving) category than for the animals (living) category. Conclusions: Results suggest that repeated exposure to and practice in retrieving category exemplars facilitate short‐term (over a 1‐hour time interval) implicit and explicit learning and semantic activation in AD participants with very mild to moderately severe dementia. Future directions include exploring the length of time over which this explicit and implicit learning is maintained post‐intervention. The differential learning curve for living versus nonliving exemplars observed here is suggestive and requires further investigation under more rigorous conditions.

Cognitive-Linguistic Interventions for Persons With Dementia: A Practitioner's Guide to 3 Evidence-Based Techniques

The purpose of this article is to present practitioners with current empirical evidence on 3 nonpharmacological, cognitive-linguistic interventions for persons with dementia. We begin with a brief review of cognitive-communicative functioning in Alzheimer disease, followed by presenting rationale for conducting comprehensive assessments and systematic interventions for persons with dementia. We then review recently published evidence and new empirical data on the treatment outcomes of 3 contemporary intervention approaches—spaced retrieval training, use of memory books and wallets, and Montessori-based interventions. These interventions were selected on the basis of high quality, replicable evidence of positive treatment outcomes, interdisciplinary appeal, and potential for optimizing functioning and quality of life of persons with dementia and their caregivers.

Teaching Future Providers about Dementia: The Impact of Service Learning

In this article, we describe an innovative approach for providing speech-language pathology graduate students with exposure to long-term care settings and clinical training in service delivery for persons with dementia. Our pedagogical approach emphasizes leading learners through distinct stages of creating awareness and a foundation of knowledge, teaching clinical skills, hands-on practice via service learning, and ongoing self-reflection. Outcome data presented in this article are derived from learner evaluations and written reflections as well as social validation data provided by dementia patients in a long-term care setting. Our findings reveal that a combination of high-impact practices, community-based service learning, and ongoing reflection can result in transformative learning and attitude shifts for speech-language pathology graduate students toward serving persons with dementia. This is a key finding given that a majority of our learners had little exposure to long-term care environments or had any prior interaction with persons with dementia.

Person-centered Feeding Care: A Protocol to Re-introduce Oral Feeding for Nursing Home Patients with Tube Feeding.

BackgroundAlthough the literature on nursing home (NH) patients with tube feeding (TF) has focused primarily on the continuation vs. discontinuation of TF, the reassessment of these patients for oral feeding has been understudied. Re-assessing patients for oral feeding may be better received by families and NH staff than approaches focused on stopping TF, and may provide an opportunity to address TF in less cognitively impaired patients as well as those with end-stage conditions. However, the literature contains little guidance on a systematic interdisciplinary team approach to the oral feeding reassessment of patients with TF, who are admitted to NHs.MethodsThis project had two parts that were conducted in one 170-bed intermediate/skilled, Medicare-certified NH in Honolulu, Hawai‘i. Part 1 consisted of a retrospective observational study of characteristics of TF patients versus non-tube fed patients at NH admission (2003-2006) and longitudinal follow-up (through death or 6/30/2011) with usual care of the TF patients for outcomes of: feeding and swallowing reassessment, goals of care reassessment, feeding status (TF and/or per oral (PO) feedings), and hospice status. Part 2 involved the development of an interdisciplinary TF reassessment protocol through working group discussions and a pilot test of the protocol on a new set of patients admitted with TF from 2011-2014.ResultsPart 1: Of 238 admitted patients, 13.4% (32/238) had TF. Prior stroke and lack of DNR status was associated with increased likelihood of TF. Of the 32 patients with TF at NH admission, 15 could communicate and interact (mild, moderate or no cognitive impairment with prior stroke or pneumonia); while 17 were nonverbal and/or bedbound patients (advanced cognitive impairment or terminal disease). In the more cognitively intact group, 9/15 (60%) were never reassessed for tolerance of oral diets and 10/15 (66.7%) remained with TF without any oral feeding until death. Of the end-stage group, 13/17 (76.5%) did not have goals of care reassessed and remained with TF without oral feeding until death. Part 2: The protocol pilot project included all TF patients admitted to the facility in 2011-2014 (N=33). Of those who were more cognitively intact (n=22), 21/22 (95.5%) had swallowing reassessed, 11/22 (50%) resumed oral feedings but 11 (50%) failed reassessment and continued exclusive TF. Of those with end-stage disease (n=11), 100% had goals of care reassessed and 9 (81.8%) families elected individualized oral feeding (with or without TF).ConclusionUsing findings from our retrospective study of usual care, our NH’s interdisciplinary team developed and pilot-tested a protocol that successfully reintroduced oral feedings to tube-fed NH patients who previously would not have resumed oral feeding.

Teaching about aphasia: speech-language pathology students’ perceptions of different instructional techniques

Background: Speech-language pathology (SLP) instructors are deeply invested in innovative, evidence-based methods for teaching future clinicians about aphasia. In medicine and allied health education, evidence exists for the benefits of planned interactions between students and patients in class or in the context of service learning, wherein students complete an organized activity for clinical or community service, followed by written reflection to foster deep learning and appreciation of practitioner responsibility. Published evidence on the scholarship of teaching and learning also reveals support for using movies to teach medical providers and SLP students about particular patient populations (Baños & Bosch, 2015; Mahendra, Fremont, & Dionne, 2013). In teaching about aphasia, there is a compelling case for including direct exposure to persons with aphasia (PwA) as invited speakers. First, in aligning with core values of the Life Participation Approach to Aphasia, PwA need more opportunities to engage as citizen experts, tell their stories, and raise awareness about aphasia. Next, despite SLPs having a key role in aphasia rehabilitation, many SLP students do not receive adequate training for working effectively with PwA (Finch et al, 2013). Further, PwA have a firsthand, lived experience of aphasia and are critical stakeholders in shaping the training of future SLPs (Purves, Petersen, & Purveen, 2013). Finally, clients have clear perceptions of valuable SLP skills and such perspectives impact students more when shared directly by PwA (Elman, Bernstein-Ellis, & Mahendra, 2017). Aims: The purpose of this study is to present SLP students’ perceptions of different instructional techniques, used to teach about aphasia in a required graduate course. Three instructional techniques were compared: interactive lectures with audiovisual material, a biographical movie about a PwA and written reflection, and live interactions with PwA as invited speakers. Data for comparing these techniques were obtained from (a) graduate student ratings and reflections about perceived efficacy of each technique and (b) instructor reflection on pros and cons, and learning outcomes resulting from each technique. Methods and procedures: Institutional Review Board approval was obtained to use student ratings and reflections as data, examining preference for instructional techniques for teaching about aphasia. This study was implemented in two separate sections of a graduate speech pathology course. Forty-five graduate students (43 women, 2 men)

Overview of Aphasia and Approaches to Aphasia Intervention

Aphasia is an acquired neurogenic language disorder characterized by impairment of an individual’s ability to comprehend and produce language symbols for everyday communication. Aphasia is the most common communication disorder resulting from brain damage. Cerebrovascular accidents (CVAs) or strokes are the leading cause of aphasia in adults. However, aphasia also may result from brain trauma, brain tumors, or a specific inflammatory or neurodegenerative disease process.