This report provides an overview of the adverse effects of the antiepileptic drug topiramate. Specifically, it evaluates the negative cognitive-communication effects of topiramate on individuals with epilepsy and postulates that treating these deficits is within the scope of practice of speech-language pathologists. It begins with a discussion on epilepsy, description of seizures, and the mechanism of action for antiepileptic drugs. It then provides an overview of cognitive communication deficits caused by antiepileptic drugs, including: memory problems, impairments in attention, and executive dysfunction. The final section provides an outline of potentially beneficial treatments a speech-language pathologist may provide to patients experiencing adverse effects from topiramate and how continued research can expand this area of practice. / text

Objective: To examine sleep and wake disorders following traumatic brain injury (TBI) and their impact on recovery of cognition, communication and mood. Research Design: This three-manuscript thesis comprises an introduction to sleep in the context of human function and development. It is followed by a systematic review of the literature pertaining to sleep and wake disorders following TBI, and then explores the relationship between sleep and arousal disturbance and functional recovery of cognitive-communication through a single case study, pre–post intervention. Finally, a larger study longitudinally explores the impact of treatment to optimize sleep and wakefulness on recovery of cognition, communication and mood through objective and subjective measures, pre-post intervention. The thesis concludes with a chapter that addresses the implications of findings for rehabilitation from the perspective of the International Classification of Functioning, Disability and Health (ICF), and a presentation of future research directions for the field Methods: The first manuscript involved a systematic review and rating of the quality of evidence. The second manuscript involved the evaluation of sleep and wakefulness by objective measures, and longitudinally by self-report through the Daily Cognitive-Communication and Sleep Profile (DCCASP, © Wiseman-Hakes 2008, see Appendix S). Cognitive-communication abilities were also measured by the DCCASP. The third manuscript utilized a single case series and cohort design to evaluate sleep and wakefulness, and to examine cognition, communication and mood at baseline and following optimization of sleep and wakefulness. Results: For Manuscript One, 43 articles were reviewed for levels and quality of evidence across 5 domains: epidemiology, pathophysiology, neuropsychological implications, intervention and paediatrics. In Manuscript Two, we showed that there was a statistically and functionally significant relationship between perceived quality of sleep and language processing, attention and memory, seen across the phases of the intervention. In Manuscript Three, we showed that there were statistically and functionally significant improvements across several domains of cognition, communication and mood in response to treatment. Conclusions: Sleep and wake disorders after TBI are pervasive, and can negatively impact rehabilitation and recovery. There is a need for systematic evaluation and intervention for these disorders in all persons with TBI.

Objective: To examine sleep and wake disorders following traumatic brain injury (TBI) and their impact on recovery of cognition, communication and mood. Research Design: This three-manuscript thesis comprises an introduction to sleep in the context of human function and development. It is followed by a systematic review of the literature pertaining to sleep and wake disorders following TBI, and then explores the relationship between sleep and arousal disturbance and functional recovery of cognitive-communication through a single case study, pre–post intervention. Finally, a larger study longitudinally explores the impact of treatment to optimize sleep and wakefulness on recovery of cognition, communication and mood through objective and subjective measures, pre-post intervention. The thesis concludes with a chapter that addresses the implications of findings for rehabilitation from the perspective of the International Classification of Functioning, Disability and Health (ICF), and a presentation of future research directions for the field Methods: The first manuscript involved a systematic review and rating of the quality of evidence. The second manuscript involved the evaluation of sleep and wakefulness by objective measures, and longitudinally by self-report through the Daily Cognitive-Communication and Sleep Profile (DCCASP, © Wiseman-Hakes 2008, see Appendix S). Cognitive-communication abilities were also measured by the DCCASP. The third manuscript utilized a single case series and cohort design to evaluate sleep and wakefulness, and to examine cognition, communication and mood at baseline and following optimization of sleep and wakefulness. Results: For Manuscript One, 43 articles were reviewed for levels and quality of evidence across 5 domains: epidemiology, pathophysiology, neuropsychological implications, intervention and paediatrics. In Manuscript Two, we showed that there was a statistically and functionally significant relationship between perceived quality of sleep and language processing, attention and memory, seen across the phases of the intervention. In Manuscript Three, we showed that there were statistically and functionally significant improvements across several domains of cognition, communication and mood in response to treatment. Conclusions: Sleep and wake disorders after TBI are pervasive, and can negatively impact rehabilitation and recovery. There is a need for systematic evaluation and intervention for these disorders in all persons with TBI.

Conversation is a highly interactive and coordinated effort between interactants. For example, interactants often mimic the behaviors and speech of one another and coordinate the timing of behaviors, or interactional synchrony. Despite being affected in certain neurological and psychiatric disorders, the neural mechanisms underlying these processes are not understood. The goal of this study is to understand the role of the ventromedial prefrontal cortex (vmPFC), an area of the brain involved in social and emotional behavior, for interpersonal coordination, including mimicry and interactional synchrony. To test the role of the vmPFC for mimicry, normal comparison (NC), brain damaged comparison (BDC), and participants with vmPFC damage interacted in two sessions with a research assistant (RA) who was performing a target behavior (1st session: nodding, 2nd session: face touching). The amount of time the participants spent nodding or touching their face in each session was recorded. NC and BDC participants tended to mimic the partner and nodded slightly more in the session in which the RA was nodding, and touched their face slightly more in the session in which the RA was touching their face. In contrast, vmPFC patients showed no difference in their behaviors in either session, suggesting that they were not influenced by the partner's behaviors and did not mimic them. In a second experiment, all of the above participant groups had a naturalistic conversation with an unfamiliar interactional partner. The conversational data were analyzed for numerous aspects of interpersonal coordination, including convergence of number of words, words per turn and backchannels, reciprocity of self-disclosures, the use of questions, interactional synchrony, and a time series analysis of response latency and speech rate. The vmPFC participants performed consistently worse than NC participants on convergence of words and words per turn, self-disclosures and asking questions. All brain-damaged participants were impaired on aspects of interactional synchrony, and no conclusive results were found for the time series analysis of response latency and speech rate. This study provides support for the hypothesis that the vmPFC is important for interpersonal coordination as the vmPFC group differed significantly from the NC group on the majority of the analyses. The final goal of this study was to understand the effects of traumatic brain injury (TBI) on interpersonal coordination. TBI patients participated in all of the experiments described above and preliminary results showed that they also seemed to be impaired on the mimicry task, and they performed slightly worse than NC participants on many of the interpersonal coordination analyses of the conversational data. This suggests that TBI also does seem to affect certain aspects of interpersonal coordination.

abstract: Mild TBI (mTBI) has been associated with subtle executive function (EF) and cognitive-communication deficits. In bilinguals, there are unique cognitive demands required to control and process two languages effectively. Surprisingly, little is known about the impact of mTBI on EF, communication, and language control in bilinguals. Therefore, the aim of this study was to examine the cognitive-communication abilities in bilinguals with a history of mTBI, identify any language control impairments, and explore the relationship between these language control impairments and domain-general cognitive control abilities. To this end, three-hundred and twenty-seven monolingual and bilingual college students with and without mTBI history participated in two experiments. In these experiments, EF, communication, and language control were examined using experimental and clinical tasks as well as self-rating scales. In Experiment 1, there was an interaction between mTBI history and language group (monolinguals vs. bilinguals) in how participants performed on a clinical measure of EF and a verbal fluency task. That is, only bilinguals with mTBI scored significantly lower on these tasks. In addition, there was a significant correlation between errors on a language switching task and performance on non-verbal EF tasks. In Experiment 2, a subgroup of bilinguals with persistent cognitive and behavioral symptoms reported greater everyday communication challenges in their first and second languages. Also, unbalanced bilinguals reported greater EF difficulties than monolinguals and balanced bilinguals regardless of mTBI history. In conclusion, bilinguals may face unique cognitive-communication challenges after mTBI. Factors related to the bilingual experience (e.g., language balance, daily language use) should be considered in clinical evaluation and future research. / Dissertation/Thesis / Doctoral Dissertation Speech and Hearing Science 2020

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Intimate partner violence occurs globally at alarming rates. Many experience adverse health impacts such as traumatic brain injury. Healthcare providers do not know the role of the speech-language pathologist, or the rehabilitation needs of survivors. Aims: This scoping review aims to identify speech-language pathology services for survivors of intimate partner violence with a resulting traumatic brain injury, and knowledge of healthcare providers on the rehabilitation needs of this population. A search was completed in May to October 2023, resulting in a total of 13 articles reviewed. Main contributions: Speech-language pathologists lack knowledge to provide services to intimate partner violence survivors with a resulting traumatic brain injury. Healthcare providers that work with survivors are unaware of the rehabilitation needs of survivors. Conclusions: Healthcare providers require knowledge of the needs of intimate partner violence survivors with a traumatic brain injury. Research regarding this population is warranted to meet their needs.

General lack of awareness regarding neurogenic communication disorders generally, and cognitive-communicative disorders following a traumatic brain injury (TBI) specifically has resulted in pervasive environmental and attitudinal barriers for these individuals. Paradigm shifts within the rehabilitation context have been highlighted which aim to remove barriers, provide social supports, and thereby enhance their participation in all aspects of life. While collaborative communication partner training programs have been advocated as a means to achieve this, a dearth of published programs is evident within the field of TBI, leading to the need for such programs to enhance the awareness and skill of the communication partner, and reduce barriers for the individual. Transformations are likewise apparent in the corporate context, where in spite of legislative changes encouraging diversity awareness programs for employees, few training programs exist worldwide, and in South Africa particularly, which remove barriers between employees and customers with a communication disability, and a TBI specifically. The current research targeted the retail supermarket environment as a context in which a significant number of everyday communicative exchanges take place. The study investigated the ability of a group of sales assistants to identify barriers to, and facilitators of interaction involving customers with a cognitive-communication disorder, using a control group design. This was achieved by the development and administration of 2 questionnaires on 2 different occasions to determine the confidence and skill with which they identified barriers and facilitators during videotaped sales interactions. A once-off training session was developed and conducted with the experimental group participants, in order to increase their confidence and skill in identifying barriers and facilitators of such interactions. The training session employed a number of customized components considered to be powerful contributors to the positive outcome of the study. These included: extensive use of customized video material professionally produced and comprising real interactions involving individuals with a TBI as “customers” in various stores of the participating national supermarket chain during operating hours. Collaboration with an individual with a TBI in the training, together with use of adult learning and diversity awareness principles were considered effective in shifting previous attitudes and fostering new learning. Inter-and-intra-group results on the confidence and skill constructs of the pre-and-post questionnaires were examined. All pointed consistently to the impact of the training session on the improvement demonstrated in the experimental group as compared to the control group on the post-questionnaires as compared with the pre-questionnaires. In addition all subjective training session evaluations by the experimental group participants were consistently highly rated, reflecting the active participation observed during training. The need for companies to expand their concept of customer service to include an acknowledgement of the customer with a disability is emphasized. Training programs empowering their employees to interact with greater awareness and confidence with customers with a TBI specifically will potentially facilitate deeper participation for both. The current research lays the groundwork for more in-depth research that can be generalized beyond this specific population of individuals with a communication disorder. / Thesis (DPhil (Communication Pathology))--University of Pretoria, 2007. / Centre for Augmentative and Alternative Communication / unrestricted