Mapping therapy for sentence production impairments in nonfluent aphasia

This study investigated a new treatment in which sentence production abilities were trained in a small group of individuals and nonfluent aphasia. It was based upon a mapping therapy approach which holds that sentence production and comprehension impairments are due to difficulties in mapping between the meaning form (thematic roles) and the syntactic form of sentences. We trained production of both canonical and noncanonical reversible sentences.Three patients received treatment and two served as control participants. Patients who received treatment demonstrated acquisition of all trained sentence structures. They also demonstrated across-task generalisation of treated and some untreated sentence structures on two tasks of constrained sentence production, and showed some improvements on a narrative task. One control participant improved on some of these measures and the other did not. There was no noted improvement in sentence comprehension abilities following treatment. Results are discussed with reference to the heterogeneity of underlying impairments in sentence production impairments in nonfluent patients, and the possible mechanisms by which improvement in sentence production might have been achieved in treatment

ALK1 SIGNALING IS REQUIRED FOR DIRECTED ENDOTHELIAL CELL MIGRATION IN THE PREVENTION OF ARTERIOVENOUS MALFORMATIONS

ALK1, a TGF-β type I receptor serine/threonine kinase, is critical for proper vascular development. Heterozygous loss of ALK1 results in the vascular disorder, hereditary hemorrhagic telangiectasia type 2 (HHT2), which is characterized by the development of arteriovenous malformations (AVMs) and affects 1:8000 people worldwide. alk1-/- zebrafish develop embryonic lethal AVMs which form via a two-step mechanism. First, loss of alk1 results in an increase in endothelial cell number in cranial arteries, which results in increased vessel caliber. In the second step, normally transient connections between arteries and veins are maintained as an adaptive mechanism to cope with an increased hemodynamic load. Using zebrafish as a tool to study the AVM formation due to loss of Alk1 signaling, I have found that Alk1 is required for directed arterial endothelial cell migration in opposition to blood flow. Embryos lacking alk1 experience a redistribution of cells, with endothelial cells failing to efficiently migrate against the direction of blood flow and accumulating in more distal regions of alk1-dependent arteries. This altered cellular distribution causes an increase in arterial caliber and consequent retention of downstream arteriovenous connections, resulting in fatal AVMs. Notch and ALK1 have been implicated in arterial specification and loss of function of either pathway causes AVMs. Furthermore, ALK1 can cooperate with Notch to upregulate expression of Notch target genes in cultured endothelial cells. These findings have led to the hypothesis that Notch and ALK1 collaboratively program arterial identity and prevent AVMs. I modulated Notch and Alk1 activities in zebrafish embryos and examined effects on Notch target gene expression and vascular morphology. Results demonstrate that control of Notch targets is context-dependent, with gene-specific and region-specific requirements for Notch and Alk1. Although loss of alk1 increases expression of dll4, which encodes a Notch ligand, and enhanced Notch signaling causes AVMs, AVMs in alk1 mutants could neither be phenocopied by Notch activation nor rescued by Notch inhibition. In conclusion, Alk1 is dispensable for acquisition and maintenance of arterial identity, and perturbations in Notch signaling cannot account or AVM development in alk1 mutants

Therapy outcome in two individuals with jargon aphasia and neologisms

Two individuals with jargon aphasia with similar clinical profiles received identical phonological therapy but responded differently to the therapy-P9 did not show any positive gains but FF showed improved naming. Analysis showed that FF and P9 had comparable performance in the semantic domain but P9 had poorer phonological skills. FF also showed a decrease in the number of neologisms and an increase in similarity with the target following therapy. Discussion will focus on the importance of exploring underlying linguistic processes before initiating therapy and the importance of analyzing both quality and quantity of errors to measure the impact of therapy

Methods to Enhance Verbal Communication between Individuals with Alzheimer's Disease and Their Formal and Informal Caregivers: A Systematic Review

Alzheimer's disease is the leading cause of dementia in older adults. Although memory problems are the most characteristic symptom of this disorder, many individuals also experience progressive problems with communication. This systematic review investigates the effectiveness of methods to improve the verbal communication of individuals with Alzheimer's disease with their caregivers. The following databases were reviewed: PsychINFO, CINAHL, EMBASE, MEDLINE, REHABDATA, and COMDIS. The inclusion criteria were: (i) experimentally based studies, (ii) quantitative results, (iii) intervention aimed at improving verbal communication of the affected individual with a caregiver, and (iv) at least 50% of the sample having a confirmed diagnosis of Alzheimer's disease. A total of 13 studies met all of the inclusion criteria. One technique emerged as potentially effective: the use of memory aids combined with specific caregiver training programs. The strength of this evidence was restricted by methodological limitations of the studies. Both adoption of and further research on these interventions are recommended

Observational Outcome Measures to Evaluate Assistive Technology Use by People with Dementia - Report Series # 12

This report describes a digital video-audio behavioural observation methodology for use in a naturalistic setting to evaluate communication rehabilitation interventions for older adults with dementia. Behavioural observation via recorded video-audio offers a number of advantages over other data collection methodologies, which can be subject to a number of biases and limitations, some of which are discussed. In this study, high quality digital audio-video recordings were collected on participants attending a respite care day program. Recording equipment was inconspicuously placed, and measurement occurred either during normal day-to-day activities or during more directed activities (e.g., playing bingo). The recordings can be used to document the occurrence of behaviours and paired behaviours of interest over extended periods of time or selected samples of interest can be downloaded for detailed analysis including lag-sequential analyses. It was found that behavioural observation can complement traditional objective measures of impairment and subjective questionnaire measures, in accordance with the World Health Organization’s (WHO) International Classification of Functioning, Disability, and Health (2001)

Cognitive Training to Enhance Aphasia Therapy (Co-TrEAT): A Feasibility Study

Persons with aphasia (PWA) often have deficits in cognitive domains such as working memory (WM), which are negatively correlated with recovery, and studies have targeted WM deficits in aphasia therapy. To our knowledge, however, no study has examined the efficacy of multi-modal training which includes both WM training and targeted language therapy. This pilot project examined the feasibility and preliminary efficacy of combining WM training and naming therapy to treat post-stroke PWA. Chronic PWA were randomly assigned to either the a) Phonological Components Analysis (PCA) and WM intervention (WMI) condition (i.e., a computerized adaptive dual n-back task), or b) PCA and active control condition (WMC). Participants received face-to-face PCA therapy 3 times/week for 5 weeks, and simultaneously engaged in WM training or the active control condition five times/week, independently at home. Six PWA were enrolled, 3 in each condition. Feasibility metrics were excellent for protocol compliance, retention rate and lack of adverse events. Recruitment was less successful, with insufficient participants for group analyses. Participants in the WMI (but not the WMC) condition demonstrated a clinically significant (i.e., > 5 points) improvement on the Western Aphasia Battery- Aphasia Quotient (WAB-R AQ) and Boston Naming Test after therapy. Given the small sample size, the performance of two individuals, matched on age, education, naming accuracy pre-treatment, WAB-R AQ and WM abilities was compared. Participant WMI-3 demonstrated a notable increase in WM training performance over the course of therapy; WMC-2 was the matched control. After therapy, WMI-3's naming accuracy for the treated words improved from 30 to 90% (compared to 30–50% for WMC-2) with a 7-point WAB-R AQ increase (compared to 3 for WMC-2). Improvements were also found for WMI-3 but not for WMC-2 on ratings of communicative effectiveness, confidence and some conversation parameters in discourse. This feasibility study demonstrated excellent results for most aspects of Co-TrEAT. Recruitment rate, hampered by limited resources, must be addressed in future trials; remotely delivered aphasia therapy may be a possible solution. Although no firm conclusions can be drawn, the case studies suggest that WM training has the potential to improve language and communication outcomes when combined with aphasia therapy

Stroke and Aphasia in Canada

As is the case in many areas of the world, aphasia treatment is far from being a priority within the Canadian healthcare system. This poster represents one part of a larger initiative planned to begin addressing the challenges of aphasia intervention and developing aphasia research capacity in Canada by aligning with the stroke community. While the presentation will focus on the Canadian experience in the area of stroke and aphasia, we hope to stimulate an international exchange of views

Adaptation and reliability of the Cinderella story retell task in Canadian French persons without brain injury

Purpose: Main concept (MC) analysis is a well-documented method of discourse analysis in adults with and without brain injury. This study aims to develop a MC checklist that is culturally and linguistically adapted for Canadian French speakers and examine its reliability. We also documented microstructural properties and provide a normative reference in persons not brain injured (PNBIs). Method: Discourse samples from 43 PNBIs were collected. All participants completed the Cinderella story retell task twice. Manual transcription was performed for all samples. The 34 MCs for the Cinderella story retell task were adapted into Canadian French and used to score all transcripts. In addition, microstructural variables were extracted using Computerized Language Analysis (CLAN). Intraclass correlation coefficients were computed to assess interrater reliability for MC codes and microstructural variables. Test–retest reliability was assessed using intraclass correlations, Spearman's rho correlations, and the Wilcoxon signed-ranks test. Bland–Altman plots were used to examine the agreement of the discourse measures between the two sessions. Results: The MC checklist for the Cinderella story retell task adapted for Canadian French speakers is provided. Good-to-excellent interrater reliability was obtained for most MC codes; however, reliability ranged from poor to excellent for the “inaccurate and incomplete” code. Microstructural variables demonstrated excellent interrater reliability. Test–retest reliability ranged from poor to excellent for all variables, with the majority falling between moderate and excellent. Bland–Altman plots illustrated the limits of agreement between test and retest. Conclusions: This study provides the MC checklist for clinicians and researchers working with Canadian French speakers when assessing discourse with the Cinderella story retell task. It also addresses the gap in available psychometric data regarding test–retest reliability in PNBIs

An inpatient rehabilitation model of care targeting patients with cognitive impairment

BACKGROUND: The course and outcomes of hip fracture patients are often complicated by the presence of dementia and delirium, referred to as cognitive impairment (CI), which limits access to in-patient rehabilitation. In response to this concern, members of our team developed and piloted an in-patient rehabilitation model of care (Patient-Centred Rehabilitation Model; PCRM) targeting patients with hip fracture and CI (PCRM-CI). We are now conducting a 3-year study comparing an inpatient rehabilitation model of care for community dwelling individuals with hip fracture and CI (PCRM-CI) to usual care to determine whether it results in improved mobility at the time of discharge from inpatient rehabilitation. METHODS/DESIGN: A non-equivalent pre-post design is being used to evaluate the PCRM-CI compared to usual care. All community dwelling (private home or retirement home) patients following a hip fracture are eligible to participate. Recruitment of both cohorts is taking place at two facilities. Target accrual is 70 hip fracture patients in the PCRM-CI cohort and 70 patients in the usual care cohort. We are also recruiting 70 health care providers (HCPs), who are being trained to implement the PCRM-CI, and their unit managers. Patient data are collected at baseline, discharge, and 6 months post-discharge from an inpatient rehabilitation program. Evaluations include mobility, physical function, and living arrangement. Additional outcome variables are being collected from medical records and from the patients via their proxies. Data on the prevalence and severity of dementia and delirium are being collected. Staff data are collected at baseline and one year after implementation of the model to determine change in staff knowledge and attitudes toward patients with hip fracture and CI. Bi-monthly semi-structured interviews with unit managers have been conducted to examine factors and barriers influencing the model implementation. Data collection began in 2009 and is expected to be completed in 2012. The control cohort of 70 patients has been recruited, and 45 patients have been accrued to the intervention group to date. DISCUSSION: Evaluation of this model of care is timely given the increasing proportion of persons with cognitive impairment and hip fractures. TRIAL REGISTRATION: The study is registered at http://clinicaltrials.gov, Identifier NCT01566136