Sarah E. Wallace

Cognitive-Motor Interference During Functional Mobility After Stroke: State of the Science and Implications for Future Research

Cognitive-motor interference (CMI) is evident when simultaneous performance of a cognitive task and a motor task results in deterioration in performance in one or both of the tasks, relative to performance of each task separately. The purpose of this review is to present a framework for categorizing patterns of CMI and to examine the specific patterns of CMI evident in published studies comparing single-task and dual-task performance of cognitive and motor tasks during gait and balance activities after stroke. We also examine the literature for associations between patterns of CMI and a history of falls, as well as evidence for the effects of rehabilitation on CMI after stroke. Overall, this review suggests that during gait activities with an added cognitive task, people with stroke are likely to demonstrate significant decrements in motor performance only (cognitive-related motor interference), or decrements in both motor and cognitive performance (mutual interference). In contrast, patterns of CMI were variable among studies examining balance activities. Comparing people poststroke with and without a history of falls, patterns and magnitude of CMI were similar for fallers and nonfallers. Longitudinal studies suggest that conventional rehabilitation has minimal effects on CMI during gait or balance activities. However, early-phase pilot studies suggest that dual-task interventions may reduce CMI during gait performance in community-dwelling stroke survivors. It is our hope that this innovative and critical examination of the existing literature will highlight the limitations in current experimental designs and inform improvements in the design and reporting of dual-task studies in stroke.

Family information needs about aphasia

Background: Comprehensive aphasia treatment includes interventions aimed at assisting family and friends in learning about and adjusting to aphasia. These interventions include education-oriented information, counselling and support, and communication skill training. While the need for family training and support is recognised, there is very little empirical evidence about the content or value of such assistance at different stages of aphasia.Aims: The primary objective of this study was to identify information needed by family members at the onset of aphasia (hospitalisation), initial rehabilitation, and chronic phases of aphasia.Methods and Procedures: A qualitative approach was used for this study. Focus groups of four to six participants were interviewed. Transcripts from the focus groups were analysed using a five-stage framework approach: familiarisation, identifying a thematic framework, indexing, charting, and mapping with interpretation. A total of 16 adult family members participated in the study.Results: Three thematic recommendations were identified across the three time periods. Based on number of times cited, family members rated information about aphasia most important, followed by psychosocial support and hopefulness. The specific type of information needed by families varied depending on the time post-onset of aphasia.Conclusions: Results from this study support research and educational materials that address the needs of family members of people with aphasia. This research provides guidelines for information from the perspective of a family member.

Using visual scene displays to create a shared communication space for a person with aphasia

Background: Low-tech visual scene displays (VSDs) combine contextually rich pictures and written text to support the communication of people with aphasia. VSDs create a shared communication space in which a person with aphasia and a communication partner co-construct messages. Aims: The researchers examined the effect of low-tech VSDs on the content and quality of communicative interactions between a person with aphasia and unfamiliar communication partners. Methods & Procedures: One person with aphasia and nine unfamiliar communication partners engaged in short, one-on-one conversations about a specified topic in one of three conditions: shared-VSDs, non-shared-VSDs, and no-VSDs. Data included discourse analysis scores reflecting the conceptual complexity of utterances, content unit analyses of information communication partners gathered from the interaction, and Likert-scale responses from the person with aphasia about his perception of communicative ease and effectiveness. Outcomes & Results: Comparisons made across conditions revealed: (a) the most conversational turns occurred in the shared-VSDs condition; (b) communication partners produced utterances with higher conceptual complexity in the shared-VSDs condition; (c) the person with aphasia conveyed the greatest number of content units in the shared-VSDs condition; and (d) the person with aphasia perceived that information transfer, ease of conversational interaction, and partner understanding were best in the shared-VSDs condition. Conclusions: These findings suggest that low-tech VSDs have an impact on the manner and extent to which a person with aphasia and a communication partner contribute to conversational interactions involving information transfer.

Navigation of a Dynamic Screen AAC Interface by Survivors of Severe Traumatic Brain Injury

The researchers examined the effect of cognitive flexibility, image contextualization, and prompt type on accuracy and speed when adults with severe traumatic brain injury (TBI) navigated dynamic screen augmentative and alternative communication (AAC) interfaces. Eighteen participants formed two groups based on cognitive flexibility status. Given matching informative versus uninformative prompts and three image contextualization conditions, participants located words on 3-level AAC systems. ANOVA computations revealed differences between groups and between prompt types for navigation accuracy; differences occurred among image conditions and between prompt types for navigation speed. Analyses using responses from participants with cognitive flexibility challenges revealed inter-subject variability regarding error types. Overall, findings suggest cognitive flexibility may predict who may and may not need explicit training to master AAC device navigation.

Reading experiences and use of supports by people with chronic aphasia

Background: Reading comprehension and efficiency limitations associated with chronic aphasia can negatively influence performance of essential, functional, and pleasure reading activities. Aims: The purpose of this phenomenological study was to describe the pre- and post-aphasia reading experiences of adults with chronic, acquired reading challenges and to understand the feelings and preferences of these individuals regarding various supports and strategies. Methods & Procedures: Six individuals with chronic reading comprehension deficits associated with aphasia completed written questionnaires, participated in semi-structured interviews, and were observed engaging with reading materials typical of those preferred pre- and post-aphasia. Outcomes & Results: Two major themes emerged from the data analysis: (1) changes in reading experiences post-aphasia and (2) use of supports and strategies to facilitate improved reading comprehension and efficiency. Although reading limitations prevented participants from resuming pre-aphasia occupations or reading activities, all continued to access personally relevant information through the written modality. All participants implemented supports and strategies to improve comprehension and efficiency as much as possible when performing functional reading tasks. Conclusions: Reading limitations can negatively impact life participation in functional and pleasurable activities post-aphasia. Although consistent themes appeared across participants, individualised preferences emerged regarding reading activities and use of supports and strategies.

Effect of two layouts on high technology AAC navigation and content location by people with aphasia

Abstract Purpose: Navigating high-technology augmentative and alternative communication (AAC) devices with dynamic displays can be challenging for people with aphasia. The purpose of this study was to determine which of two AAC interfaces two people with aphasia could use most efficiently and accurately. Method: The researchers used a BCB′C′ alternating treatment design to provide device-use instruction to two people with severe aphasia regarding two personalised AAC interfaces that had different navigation layouts but identical content. One interface had static buttons for homepage and go-back features, and the other interface had static buttons in a navigation ring layout. Throughout treatment, the researchers monitored participants’ mastery patterns regarding navigation efficiency and accuracy when locating target messages. Results: Participants’ accuracy and efficiency improved with both interfaces given intervention; however, the navigation ring layout appeared more transparent and better facilitated navigation than the homepage layout. Conclusions: People with aphasia can learn to navigate computerised devices; however, interface layout can substantially affect the efficiency and accuracy with which they locate messages. Implications for Rehabilitation Given intervention incorporating errorless learning principles, people with chronic aphasia can learn to navigate across multiple device levels to locate target sentences. Both navigation ring and homepage interfaces may be used by people with aphasia. Some people with aphasia may be more consistent and efficient in finding target sentences using the navigation ring interface than the homepage interface. Additionally, the navigation ring interface may be more transparent and easier for people with aphasia to master – that is, they may require fewer intervention sessions to learn to navigate the navigation ring interface. Generalisation of learning may result from use of the navigation ring interface. Specifically, people with aphasia may improve navigation with the homepage interface as a result of instruction on the navigation interface, but not vice versa.

Functional brain injury rehabilitation: survivor experiences reported by families and professionals

Primary objective: The researchers investigated rehabilitation experiences of brain injury (BI) survivors participating in a functional programme. Research design: The researchers used a phenomenological approach involving the collection of artifacts and the analysis of focus group discussions through horizontalizing statements, creating meaning units and clustering codes. Methods and procedures: Focus groups including staff members and survivors’ relatives reported perceptions about the programme and survivors’ experiences; programme artifacts (e.g. survivors’ schedules, website information) provided additional information. Survivors verified focus group responses and an analysis using five assessment measures served to validate positive functional changes among programme participants. Main outcomes: Three general categories of themes emerged: components of functional therapy, programme/culture features supporting functional therapy and family members’ and survivors’ reactions to a functional programme. Sub-categories and themes provided details about issues central to functional BI treatment. Conclusions: The findings suggest that functional therapy programmes: (a) address family and survivors’ goals, (b) occur in the community or real world, (c) are implemented by people in survivors’ environments, (d) are collaborative, (e) focus on a positive culture, (f) build on basic skills, (g) allow exploration of discharge options, (h) preserve survivors’ privacy and dignity and (i) recognize difficulties associated with transitioning from acute to post-acute rehabilitation.

Speech Language Pathologists' Opinions of Constraint-Induced Language Therapy

Abstract Background: Constraint-induced language therapy (CILT) has received recent attention as a possible intervention to improve expressive language in people with nonfluent aphasia. Difficulties have been reported with the practical implementation of constraint-induced movement therapy due to its intensive treatment parameters. It remains unknown whether similar challenges may exist with CILT. Objective: To determine the opinions of speech-language pathologists (SLPs) about CILT for people with nonfluent aphasia. Method and Procedures: One hundred sixty-seven SLPs completed an electronic survey assessing their opinions of various aspects of CILT. Outcomes and Results: Over 60% of participants felt that people with aphasia would be very unlikely or somewhat unlikely to adhere to CILT. The majority felt that people with aphasia would hold high or moderate concerns with the number of hours spent in therapy (high, 41.8%; moderate, 31.4%), the number of days spent in therapy (high, 44.4%; moderate, 24.8%), likelihood for managed care reimbursement (high, 74.8%; moderate, 15.2%), and other logistical issues (high, 39.2%; moderate, 30.7%). With respect to providing CILT, participants cited the number of hours of therapy (high, 37.3%; moderate, 21.6%) and the number of consecutive days of therapy (high, 29.4%; moderate, 20.3%) as concerns. There were 70.6% who indicated that their facilities lacked resources to provide CILT, and 90.9% felt that most facilitates do not have the resources to provide CILT. Conclusions: Some SLPs hold significant concerns with the administration of CILT, particularly related to its dosing and reimbursement parameters. Additional work is needed to investigate the issues that were identified in this survey using qualitative methods with SLPs and people with aphasia and to examine modified CILT protocols.

A multimodal communication program for aphasia during inpatient rehabilitation: A case study.

BACKGROUND Communication is essential for successful rehabilitation, yet few aphasia treatments have been investigated during the acute stroke phase. Alternative modality use including gesturing, writing, or drawing has been shown to increase communicative effectiveness in people with chronic aphasia. Instruction in alternative modality use during acute stroke may increase patient communication and participation, therefore resulting in fewer adverse situations and improved rehabilitation outcomes. OBJECTIVE The study purpose was to explore a multimodal communication program for aphasia (MCPA) implemented during acute stroke rehabilitation. MCPA aims to improve communication modality production, and to facilitate switching among modalities to resolve communication breakdowns. METHODS Two adults with severe aphasia completed MCPA beginning at 2 and 3 weeks post onset a single left-hemisphere stroke. Probes completed during each session allowed for evaluation of modality production and modality switching accuracy. RESULTS Participants completed MCPA (10 and 14 treatment sessions respectively) and their performance on probes suggested increased accuracy in the production of various alternate communication modalities. However, increased switching to an alternate modality was noted for only one participant. CONCLUSIONS Further investigation of multimodal treatment during inpatient rehabilitation is warranted. In particular, comparisons between multimodal and standard treatments would help determine appropriate interventions for this setting.

Generalization of word retrieval following semantic feature treatment.

OBJECTIVES The effectiveness of a Semantic Feature Treatment (SFT) at increasing word retrieval accuracy of untreated words was examined in relation to the influence of the number of shared features with treated words. Generalization of these improvements to discourse was also examined. METHODS Three adults with chronic aphasia completed 12 SFT sessions. Generalization to untreated words with many shared features (SFs) and with no shared features (NSFs), as well as generalization to discourse tasks, was analyzed. RESULTS All participants improved in word retrieval accuracy for treated words. Accuracy of retrieving untreated words improved for two participants. Retrieval accuracy for untreated words with SF improved more than for words with NSF. Generalization of improvements to discourse tasks occurred for two participants. CONCLUSIONS SFT improves word retrieval accuracy for some people with aphasia during confrontation naming and discourse tasks. Generalization may be slightly higher for untreated words with SFs than untreated words with NSFs. Future research is needed to further investigate the effect shared features have on generalization of improvements, and to determine candidacy for SFT.