Robert Goldfarb

Characteristic patterns of word association responses in institutionalized elderly with and without senile dementia

This study examined the responses of 91 institutionalized elderly persons to the Goldfarb-Halpern Word Association Test (1981), Journal of Speech and Hearing Research, 24, 233-246. Subjects with senile dementia evidenced a characteristic pattern of responses which included marked reduction of paradigmatic responses, no decrease in syntagmatic responses, and a marked increase in unclassifiable and multiword responses not previously reported in the literature. The declines and increases appeared linear and progressive with severity of dementia. The pattern was distinct from that of any other adult group previously tested with this tool. Institutionalized elderly subjects without senile dementia performed similarly to previously tested noninstitutionalized elderly. Theoretical and clinical implications are discussed.

Espousing melodic intonation therapy in aphasia rehabilitation: a case study.

A program of Melodic Intonation Therapy (MIT) was adapted as a home training procedure to enable a severely affected aphasic adult to respond to 52 simple questions bearing relevance to his daily life. MIT involves embedding short phrases or sentences in a simple, non-distinct melody pattern. As the patient progresses through the program, the melodic aspect is faded and the program eventually leads to production of the target phrase or sentence in normal speech prosody. The present procedure consisted of three levels of training designed to advance the subject from an initial level of intoning responses in a simple melody to producing the responses in normal speech prosody. The subjects wife was trained to administer MIT both in the clinical and home settings. Considerable improvement was obtained in imitation and in context related responses to questions. These findings lend support to the proposal that the music dominance to the right hemisphere assists, and perhaps diminishes the language dominance of, the damaged left hemisphere. The limitations of use of Melodic Intonation Therapy were discussed.

Accuracy of Clinical Judgment of the Chin-Down Posture for Dysphagia During the Clinical/Bedside Assessment as Corroborated by Videofluoroscopy in Adults with Acute Stroke

Speech-language pathologists tend to rely on the noninstrumental swallowing evaluation in making recommendations about a patient’s diet and management plan. The present study was designed to examine the sensitivity and specificity of the accuracy of using the chin-down posture during the clinical/bedside swallowing assessment. In 15 patients with acute stroke and clinically suspected oropharyngeal dysphagia, the correlation between clinical and videofluoroscopic findings was examined. Results identified that there is a difference in outcome prediction using the chin-down posture during the clinical/bedside assessment of swallowing compared to assessment by videofluoroscopy. Results are discussed relative to statistical and clinical perspectives, including site of lesion and factors to be considered in the design of an overall treatment plan for a patient with disordered swallowing.

Word association responses in normal adult subjects

A word association test was administered to a group of 316 undergraduate students. Word stimuli were balanced according to frequency of occurrence in written English language usage (frequent, infrequent), word length (short, long), abstraction level (low, medium, high), and grammatical class (noun, verb, adjective). Responses were analyzed according to a syntactic classification system. The factorial nature of the word list used enhances its value as a research tool.

Support systems: older adults with neurogenic communication disorders.

As the population of older adults increases, there is a corresponding increase in the number of individuals with communication disorders resulting from brain damage. The purpose of this article was to describe the effects of aphasia and dementia on language and communication, and to suggest support systems for improving communication and maximizing residual language abilities. For both these disorders, we address the psychosocial environment, the roles of professionals and caregivers, individual versus group therapy, and support groups. Finally, we report on 2 specific support groups, one for aphasia and one for Alzheimers dementia, with which the authors have been involved for many years.

COMMUNICATIVE RESPONSIBILITY AND SEMANTIC TASK IN APHASIA AND SCHIZOPHASIA

A probe technique requiring convergent and divergent semantic behavior and representing five levels of communicative responsibility served as the research tool. Stimuli were presented to 29 aphasic adults (13 Brocas, 7 Wernickes, and 9 anomic), 26 adults with chronic undifferentiated schizophrenia, and 32 normal elderly control subjects. Within each group significant differences were observed on the semantic task (convergent and divergent) and on level of communicative responsibility. Among subjects with aphasia, differences appeared to relate more to severity than type. Differences between unclassified aphasic and “schizophasic” groups occurred only when multiword responses were required. We conclude that continued use of the term “schizophasia” may be unwarranted and that the linguistic behaviors we observed in aphasia and the language of schizophrenia may contribute to differential diagnosis.

Word-Association Responses to Time-Altered Stimuli by Schizophrenic Adults

This research addressed the relationship between the speed of presentation of stimuli through the auditory and visual modalities and the number of syntagmatic and paradigmatic word-association responses of 49 chronic undifferentiated schizophrenic adults. In word-association tests administered to subjects stimuli were balanced for frequency of occurrence in written English language (frequent, infrequent), word length (long, short), abstraction level (low, medium, high), and part of speech (noun, verb, adjective). The words were presented auditorily at normal speed (equivalent to 10 phonemes per second) and at half speed (equivalent to 5 phonemes per second) speech. Words were also presented visually, using a tachistoscope, at extended fixation speed (equivalent to 1,000 msec.) and at sweep speed (equivalent to 10 msec.). Mote paradigmatic responses occurred on word stimuli if nouns, long, and frequently occurring presented auditorily; and if concrete, nouns, and presented slowly and visually. Results were compared to previously reported data for aphasic and normal adults, and differentiating features and clinical implications were discussed.

COGNITIVE DISCRIMINATION IN BRAIN-DAMAGED ADULTS: COLOR VS FORM PREFERENCE

The relative preference of color, form, and other dimensions as the basis for discrimination between stimuli has been investigated in a variety of normal and language-impaired populations. In aphasic adults, previous studies have been contradictory, and no studies of non-aphasic, brain-damaged adults have been reported. In this study color vs form preference was examined in 20 left brain-damaged, aphasic adults, 20 right brain-damaged non-aphasic adults, and 20 control subjects. Significant differences were found among all groups, with preference of color over form greatest for left brain-damaged subjects, followed by right-damaged and control subjects.

Modifying Melodic Intonation Therapy

Reports of the MIT protocol developed in the 1970s by the Boston group [2,3] emphasized that it was a language training program that used operant conditioning principles to treat adults with moderate nonfluent (Broca’s-type) aphasia. The authors reported success in increasing the expressive abilities of some individuals with aphasia for whom other clinical approaches had failed. The authors described MIT as a programmed approach with two levels of increasing difficulty, each level consisting of several steps. Short phrases or sentences were imbedded in simple, non-distinct melody patterns.

Communicative Responsibility and Semantic Task in the Language of Adults with Dementia

A probe technique requiring convergent and divergent semantic behavior and representing five levels of communicative responsibility served as the research tool. Stimuli were presented to adults identified as having Alzheimer disease or multi-infarct dementia. Within each group differences were observed on the semantic task (convergent and divergent) and on communicative responsibility. Group characteristics are compared with data previously published in 1994 on aphasic and schizophrenic adults responding to the same stimuli.