Rosemary Baker

Assessment in speech-language pathology

This seventh special issue of Language Testingis devoted to a field in which the assessment of linguistic and communicative abilities is a regular and integral activity, but one which to date has not figured highly in the pages of this journal: that of speech–language pathology. Although a small number of articles concerned with speech and language disorders have appeared in Language Testingover the years (see, for example, Fletcher and Peters, 1984; Baker, 1993), this special issue provides the first opportunity to offer readers a set of papers on this theme. There are, of course, central concerns which are common to all areas of assessment, whether this be for purposes of education, professional certification, medical diagnosis or rehabilitation. Readers will thus recognize in these papers the overriding concern with validity, i.e., that the assessment procedures yield information from which speech–language pathologists can make correct inferences regarding the existence, nature and severity of speech and language disturbances in their clients. Further, in speech–language pathology, as in other settings, the uses to which assessment results are put can have important personal, social and vocational consequences. Indeed, the design and provision of appropriate and effective therapy depends, in large part, on the quality of the information obtained from formal or informal assessments, in combination with case-history data. A second set of concerns unites all those who work on the development or investigation of language-assessment procedures in particular. In this category we include such issues as the principled sampling of language content for inclusion in a test, the availability or collection

Memory and communication support in dementia: research-based strategies for caregivers

BACKGROUND Difficulties with memory and communication are prominent and distressing features of dementia which impact on the person with dementia and contribute to caregiver stress and burden. There is a need to provide caregivers with strategies to support and maximize memory and communication abilities in people with dementia. In this project, a team of clinicians, researchers and educators in neuropsychology, psychogeriatrics, nursing and speech pathology translated research-based knowledge from these fields into a program of practical strategies for everyday use by family and professional caregivers. METHODS From the available research evidence, the project team identified compensatory or facilitative strategies to assist with common areas of difficulty, and structured these under the mnemonics RECAPS (for memory) and MESSAGE (for communication). This information was adapted for presentation in a DVD-based education program in accordance with known characteristics of effective caregiver education. RESULTS The resultant DVD comprises (1) information on the nature and importance of memory and communication in everyday life; (2) explanations of common patterns of difficulty and preserved ability in memory and communication across the stages of dementia; (3) acted vignettes demonstrating the strategies, based on authentic samples of speech in dementia; and (4) scenarios to prompt the viewer to consider the benefits of using the strategies. CONCLUSION Using a knowledge-translation framework, information and strategies can be provided to family and professional caregivers to help them optimize residual memory and communication in people with dementia. Future development of the materials, incorporating consumer feedback, will focus on methods for enabling wider dissemination.

Evaluation of a caregiver education program to support memory and communication in dementia: A controlled pretest–posttest study with nursing home staff

BACKGROUND There is a need for simple multimedia training programs designed to upskill the dementia care workforce. A DVD-based training program entitled RECAPS and MESSAGE has been designed to provide caregivers with strategies to support memory and communication in people with dementia. OBJECTIVES The aims of this study were: (1) to evaluate the effects of the RECAPS and MESSAGE training on knowledge of support strategies, and caregiver satisfaction, in nursing home care staff, and (2) to evaluate staff opinion of the training. DESIGN A multi-centre controlled pretest-posttest trial was conducted between June 2009 and January 2010, with baseline, immediately post-training and 3-month follow-up assessment. SETTING Four nursing homes in Queensland, Australia. PARTICIPANTS All care staff were invited to participate. Of the 68 participants who entered the study, 52 (37 training participants and 15 controls) completed outcome measures at baseline and 3-month follow-up. 63.5% of participants were nursing assistants, 25% were qualified nurses and 11.5% were recreational/activities officers. METHODS The training and control groups were compared on the following outcomes: (1) knowledge of memory and communication support strategies, and (2) caregiver satisfaction. In the training group, the immediate effects of training on knowledge, and the effects of role (nurse, nursing assistant, recreational staff) on both outcome measures, were also examined. Staff opinion of the training was assessed immediately post-training and at 3-month follow-up. RESULTS The training group showed a significant improvement in knowledge of support strategies from baseline to immediately post-training (p=0.001). Comparison of the training and control groups revealed a significant increase in knowledge for the training group (p=0.011), but not for the control group (p=0.33), between baseline and 3-month follow-up. Examination of caregiver satisfaction by care staff role in the training group revealed that only the qualified nurses showed higher levels of caregiver satisfaction at 3-month follow-up (p=0.013). Staff rated the training positively both for usefulness and applicability. CONCLUSION The RECAPS and MESSAGE training improved nursing home care staffs knowledge of support strategies for memory and communication, and gains were maintained at 3-month follow-up. Moreover, the training was well received by staff.

The assessment of language impairment in elderly bilinguals and second language speakers in Australia

The pattern of migration to Australia over the last sixty years has been such that by the year 2001, almost 25% of the population aged 65 or over will have a first language other than English (Rowland, 1991a). Given that there is an age-related increase in the incidence of neurologically based language impairment, the need for appropriate language assessment procedures for elderly bilinguals and speakers of English as a second language is becoming increasingly apparent to health professionals in Australia. The design of such procedures presents particular challenges, however, and it is the purpose of this article (1) to set these out and (2) to consider ways in which they might be met.

Visualising conversations between care home staff and residents with dementia

ABSTRACT People with dementia living in residential care often face the dual disadvantage of increasing difficulty with communication and reduced opportunities for conversation. Social interaction is central to wellbeing of residents with dementia, so it is important that care staff have the skills to engage in conversation with them. We studied conversations in 20 care staff–resident dyads, to examine conversation structure and content, patterns of engagement within conversations, including the topics around which engagement occurred, and communication behaviours by care staff that appeared to facilitate (or impede) participation by residents. The transcripts were analysed using Discursis, a computational information visualisation tool that allows interactive visual inspection, in context, of the contributions by each speaker, the turn-taking dynamics, and the content recurring within and between speakers. We present case examples (a) where care staff did most of the talking, initiated topics and were responsible for most recurrence of content; (b) where talk was more evenly shared between partners, with some topics initiated and/or elaborated by participants with dementia; and (c) where participants with dementia talked most, with care staff supporting the conversation. We identified accommodative strategies used by care staff, such as reflecting back the other persons responses to sustain engagement. We also noted care staff behaviours that impeded communication, such as not listening attentively and not allowing sufficient time for responses. The results from this study highlight aspects of social communication within the aged care context and suggest ways in which rewarding interactions between staff and residents with dementia might be encouraged.

Language testing and the assessment of dementia in second language settings: a case study:

Procedures commonly used for assessing cognitive function in people with suspected dementia are of questionable validity in second language settings because of possible linguistic and cultural inappropriateness. This article reports a case study of a patient of Japanese background with suspected dementia in an English-speaking geriatric unit. The subject was thought to be able to understand and speak English sufficiently well for her daily activities, but was not engaging in communication with hospital staff. The case was further complicated by a history of schizophrenia. As part of a research project concerned with language disorder in speakers of English as a second language, the subject was tested using tasks selected on the basis of current knowledge regarding language decline and deficit in dementia of the Alzheimer type (DAT). The tasks, which the subject wished to do only in Japanese, included naming, story recall and processing by semantic category. The subjects performance in her first language did not, in general, indicate her language-processing abilities to be compromised by DAT. The results demonstrate the potential contribution of information from language-based tasks administered in the persons preferred language to screening for dementia in second language settings.

An Automated Approach to Examining Conversational Dynamics between People with Dementia and Their Carers.

The progressive neuropathology involved in dementia frequently causes a gradual decline in communication skills. Communication partners who are unaware of the specific communication problems faced by people with dementia (PWD) can inadvertently challenge their conversation partner, leading to distress and a reduced flow of information between speakers. Previous research has produced an extensive literature base recommending strategies to facilitate conversational engagement in dementia. However, empirical evidence for the beneficial effects of these strategies on conversational dynamics is sparse. This study uses a time-efficient computational discourse analysis tool called Discursis to examine the link between specific communication behaviours and content-based conversational engagement in 20 conversations between PWD living in residential aged-care facilities and care staff members. Conversations analysed here were baseline conversations recorded before staff members underwent communication training. Care staff members spontaneously exhibited a wide range of facilitative and non-facilitative communication behaviours, which were coded for analysis of conversation dynamics within these baseline conversations. A hybrid approach combining manual coding and automated Discursis metric analysis provides two sets of novel insights. Firstly, this study revealed nine communication behaviours that, if used by the care staff member in a given turn, significantly increased the appearance of subsequent content-based engagement in the conversation by PWD. Secondly, the current findings reveal alignment between human- and computer-generated labelling of communication behaviour for 8 out of the total 22 behaviours under investigation. The approach demonstrated in this study provides an empirical procedure for the detailed evaluation of content-based conversational engagement associated with specific communication behaviours.

Word length and age influences on forward and backward immediate serial recall

The present research is aimed at understanding the processes involved in short-term memory and how they interact with age. Specifically, word length effects were examined under forward serial recall, backward serial recall, and item recognition tasks, with performance being interpreted within an item-order theoretical framework. The interaction of age, word length, and direction of recall was examined in two experiments, the first of which confirmed that the word length was present with forward recall and absent with backward recall. In addition, age effects were stronger in backward recall than in forward recall. In the second experiment, an item-order trade-off methodology was utilized with backward recall. When order memory was required, there was no word length effect and strong age effects. When memory was tested via an item recognition test, there was a reverse word length effect and no age effect. While word length effects can be interpreted within the item-order framework, age effects cannot.

The burden of online friends: the effects of giving up Facebook on stress and well-being

ABSTRACT People occasionally choose to cut themselves off from their online social network by taking extended breaks from Facebook. This study investigated whether abstaining from Facebook reduces stress but also reduces subjective well-being because of the resulting social disconnection. Participants (138 active Facebook users) were assigned to either a condition in which they were instructed to give up Facebook for 5 days or continue to use Facebook as normal. Perceived stress and well-being, as well as salivary cortisol, were measured before and after the test period. Relative to those in the Facebook Normal condition, those in the No Facebook condition experienced lower levels of cortisol and life satisfaction. Our results suggest that the typical Facebook user may occasionally find the large amount of social information available to be taxing, and Facebook vacations could ameliorate this stress—at least in the short term.

Person-centered communication strategies in action: A focus on residents with dementia in aged care

Globalization is challenging social gerontologists’ notions of who older migrants are and how to cater to their needs. This presentation aims to show that there are specific risks for social exclus ...Narrative foreclosure is a new sensitizing concept for studying stagnation of identity development in later life. It is defined as the conviction that no new interpretations of one’s past, nor new commitments and experiences in one’s future are possible that can substantially change one’s life story. The Narrative Foreclosure Scale (NFS) was developed to study this concept empirically. The NFS comprises two subscales: Past and Future. The psychometric properties were studied in two samples of older adults (n=247 and n = 220). Confirmatory factor analyses confirm that the scale consists of two distinct factors. Internal consistencies are sufficient to good. The validity is further confirmed by the relationship with demographics and other psychological constructs, such as personality, hope, reminiscence, ego-integrity, balanced time perspective, wisdom, depression, and positive mental health. It is discussed that diminishing narrative foreclosure may be an important process factor in life-review and narrative therapy with older adults.