Our project was designed to determine if there was a difference in vocal parameters, including mean fundamental frequency, mean amplitude, and total phonation time, between individuals diagnosed with Parkinsons disease (PD) and age-and gender-matched individuals without a diagnosis of any neurologic or neurodegenerative diseases (NO PD) using the Ambulatory Phonation Monitor (APM: KayPENTAX, Lincoln Park, New Jersey). The APM was designed to gather objective data in a naturalistic environment by having participants wear the device over the course of three 8-hour days. The APM measured total phonation time, mean amplitude, and mean fundamental frequency throughout that time. The participants wore the APM on what they deemed typical days where similar routines were observed and out of the ordinary activities did not occur. Data collection was repeated three times to establish the reliability of the data collected. Descriptive statistics and two-way repeated measure ANOVA were computed using SPSS. NO PD group exhibited significantly higher mean amplitudes in comparison to the PD group. The two groups did not differ in mean fundamental frequency or phonation time. When asked to estimate the amount of talking time, the PD group overestimated their talk time significantly more than the NO PD group. These data suggest that variability of vocal parameters exist among individuals diagnosed with PD and age matched individuals with no diagnosis of neurologic or neurodegenerative disease.

Parkinsons disease (PD) is characterized by a degeneration of the substantia nigra, resulting in a loss of dopaminergic neurons. Cognitive impairments, evident in 72% of people with PD (PWP) are indicated by deficits in visuospatial capacity, memory, executive functioning, and attention (Cooper, Sagar, Jordan, Harvey, & Sullivan, 1991; Duffy, 2005). Unfortunately, to date, there is little research that demonstrates improvement of these cognitive processes, particularly those affecting memory recall and attentional skills. The purpose of this study was to examine the effects of utilizing Attention Process Training (APT; Sohlberg & Mateer, 2005), a therapeutic protocol designed for individuals who have sustained a traumatic brain injury (TBI), on a person with Parkinsons disease to determine if improvement of various attentional processes and memory recall could be improved. The protocol set forth by Sohlberg & Mateer (2005) was administered to a PWP in 12 hours of treatment, targeting sustained, selective, and alternating attention. Evidence for treatment effect could not be determined. However, the participant did reach criteria on sustained and selective attention tasks of increasing complexity. Due to the studys time constraints, the participant received only three sessions of alternating attention and no divided attention training. From visual inspection of baseline probes for alternating and divided attention, it appeared that the participant was able to stabilize performance on percent correct and decrease his response time after receiving just sustained and selective attention training. Similar findings appeared for divided attention tasks. Changes in functional attention everyday attention measured by the Test of Everyday Attention (Robertson, Ward, Ridgeway, & Nimmo-Smith, 1994) were minimal. The most significant improvement in attentional processes was noted on the APT II Attention Questionnaire (Sohlberg, Johnson, Paule, Raskin, & Mateer, 2001), a self-report measure. The literature points toward the notion that training attention is foundational, and leads to improvement in working memory. Our results seem to bear this out, in that the participant improved on OSPAN and RSPAN automated working memory tasks (Unsworth & Spillers, 2010).

This research was designed to gain information that could be used in the future to improve quality of life measures for people with aphasia. Aphasia is a language disorder resulting from stroke or traumatic brain injury. People with aphasia exhibit difficulty producing and understanding verbal and written language. Existing quality of life measures, while valid and reliable for those with mild to moderate aphasia, are often unable to be used for those with severe aphasia. The written text is too complex for them to comprehend. Other studies have been done supporting the idea that pictures aid in the comprehension of written text. This study was intended to determine if a set of pictures from the Life Interests and Values (L!V; Haley, 2010) Cards are a good representation of the text questions from the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39; Hilari, 2003). A healthy older adult population rated the relationship of 31 picture and text combinations using a 5-point Likert Scale as well as offered suggestions to modify the pictures resulting in a closer relationship between the picture and text. The projects objective was to determine if pictures could be used to reflect text, as judged by an older adult population without neurologic disorders. It was necessary to conduct this study with healthy older adults to ensure that an unaffected individual perceives a strong symmetrical relationship between the text and pictures before attempting to use this research with individuals with aphasia. Results indicated a high agreement rate (≥ 60%) for 18 of the 31 text and picture combinations. Seven of the 18 items were judged symmetrical (ratings 4 & 5 ≥ 60%). Nine of the 18 items were judged not symmetrical. On two of the 18 items, ≥ 60% of participants agreed the picture somewhat represented the text. The remaining 13 survey items demonstrated a low agreement rate (< 60%); therefore no relationship could be determined on these items.

This studys purpose was to investigate whether language discourse follows a diurnal pattern across one 10-hour day in normal healthy aging individuals (NHA) and individuals with mild to moderate Alzheimers disease. Ten healthy older adults; and ten older adults clinically labeled with probable Alzheimers disease were recruited for this study. Measurements of procedural language, narrative language, and cognition, the Benton Judgment of Line Orientation (BJLO), were collected across one day at 9:00am, 12:00pm, 3:00 pm, and 6:00pm. Language samples were evaluated for linguistic variables to evaluate the quantity and quality of the discourse samples. Results indicated that the two groups differed significantly on their cognitive performance across the day, but cognitive performance was not correlated with any of the linguistic measures. Measures of narrative quality were significantly different between the groups. Group differences in procedural quality and quantity were non-significant. Some linguistic variables were susceptible to changes in diurnal patterns, while others were not. Diurnal effects appeared most prevalent in those with a higher cognitive status, with individuals with Alzheimers disease showing less variation in linguistic measures across the day. Clinically, these results could impact the timing and administration of cognitive exams and therapies, as to account for changes in arousal patterns. Future studies should include examinations of other linguistic variables to evaluate their susceptibility to diurnal patterns. Physiological measures should be included to provide a more objective measure of circadian rhythms.

BACKGROUND: Approximately 1 million people in the United States suffer from aphasia and > 50% of those people may demonstrate recurrent perseverations. No consensus has been forthcoming on whether (1) a therapy that directly confronts clients with imminent pre-articulatory automatisms (the perseverations) or (2) a more typical neuropsychological therapy that eschews any direct confrontation with automatic behaviors works best. PURPOSE: The purpose of this study was to determine the treatment efficacy of a non-confrontational picture naming intervention on naming ability in individuals with aphasia and recurrent perseverations. METHODS: This is a prospective single-subject ABAB multiple baseline design replicated across 3 right-handed individuals with moderate fluent aphasia subsequent to left hemisphere ischemic strokes to answer the study¡¯s experimental questions. Participants ranged from 61 to 77 years of age and ranged from 7.5 to 13.0 months post stroke. Further, the participants demonstrated total and/or blended perseverations errors on ¡Ý10% of a confrontational picture naming task that consisted of 60 items derived from the categories of the Naming in Categories subtest of the Boston Diagnostic Aphasia Examination Third Edition (Goodglass, Kaplan, & Barresi, 2001). Multiple measurements of accuracy and efficiency were taken during the naming intervention, after the intervention, and during other speech tasks including single word repetition, reading, and picture description. Consistent with single-subject design, we used visual inspection to determine whether or not improvement in picture naming associated with the non-confrontational intervention had occurred. We also opted to analyze the data using paired t-test, Ordinary Least Squares (OLS) and Generalized Least Squares (GLS) with type 1 error rate set at ¦Á = 0.05. RESULTS: All three subjects increased performance on picture naming accuracy and decreased their number of recurrent perseverative responses with intervention. Only one subject elicited anticipatory errors in this study, and he demonstrated an increase in anticipatory proportion when presented with facilitating cues compared to pre-intervention performance. Preliminary results suggested communication improvements after the intervention extended beyond the speech process undergoing treatment. Significant individual variation in improvement was seen in response to therapy. CONCLUSION: The results of this study provided preliminary evidence regarding the efficacy of a non-confrontational picture naming intervention as a strategy to improve speech accuracy and efficiency. In addition, preliminary evidence suggests that the immediate improvements are feasible with relatively short duration and frequency of intervention.

Young adolescents should be able to write organized multi-paragraph compositions that develop a central idea and unfold in logical and sequential order, unified through the use of transitional words and phrases. In other words, the compositions should not just consist of a string of related sentences, but represent a dynamic text that has coherence. It is important that speech-language pathologists develop quick and reliable methods for assessing coherence to aid in making data driven decisions and progress monitoring consistent with principles of Responsiveness to Intervention. Yet, the holistic quality of coherence makes it difficult to assess, both within a composition and developmentally. The purpose of this study was to determine a) the ability of students to produce sentences that maintain coherence across the continuum of grade levels, and b) whether or not adolescents would produce fewer errors of coherence on sentence combining exercises following six weeks of Embedded Language Lessons (ELL) instruction as compared to Discrete Language Lessons (DLL) instruction. First, 115 students in grades 4-7 completed the Sentence Combining subtest of the Test of Written Language, Third Edition (Hammill & Larsen, 1996). Four of the test items required adherence to three different coherence relations using Kehlers (2002) classifications. Those subtest items were examined to assess the students ability to create sentences that maintain coherence across the continuum of grade levels. Second, the two grade levels for which posttest data was returned were then examined for changes in coherence following a six-week classroom-based intervention designed to increase meta-awareness of coherence in text structure. Results of this study revealed evidence of a developmental progression in the ability to represent these coherence relations in written language, with the youngest students indicating the correct coherence relation in 25 to 45% of their responses and the oldest students in 41 to 79% of their responses. Only one significant group difference was found at posttest when the individual relations were considered. A significant improvement in contiguity was observed for the fifth-graders in the ELL group. No group differences were observed with respect to the cause-effect relation or with parallel structure.

The purpose of this study was to examine the validity of the DELV-ST by comparing it to two other screeners, the Fluharty-2 and the Washington-Craig Language Screener (WCLS). The participants were 73 African American Pre-K and Head Start children, aged four- to five-years-old. Fail rates were higher than what has been reported in the literature. They were highest for the Fluharty-2 (57%), lower for the DELV-ST (52%), and lowest for the WCLS (46%); however, there were no statistical differences in the fail rates by screener. Approximately 54% of the children passed or failed all screeners. Unfortunately, the remaining 46% failed one or two of the screeners, with 91% of the children failing the first or second screener given and only 9% failing the third. Thus, order or practice effects seemed to contribute to the findings. Indeed, when the overall fail rate was recalculated using the results of the third screener, the fail rate was lower at 33%. Fail rates did not vary statistically by the childrens gender, caregiver education, and use of nonmainstream English. The childrens gender, caregiver education, and use of nonmainstream English were also independent of their screening performance, except the childrens listener judgment dialect rating was positively correlated to their MCLUw, their caregiver education was positively correlated to their Receptive Language Quotient scores from the Fluharty-2 and the Wh-Question scores from the WCLS, and their age was negatively correlated to their DELV-ST error scores and positively correlated to their Fluharty-2 scores and the Wh-Question scores from the WCLS. There was also some evidence of convergent and divergent validity among the screeners; however, not all tests of these relationships provided evidence for the validity of the screeners as suggested by the test developers. Together, these findings suggest that the DELV-ST is comparable to the Fluharty-2 and the WCLS for screening low-income, AA children. Future studies are needed to evaluate the predictive validity of the three screeners and further investigate the role test practice may play in low-income, AA childrens screening results.

This prospective Phase I single-subject (ABABA) study repeated across 4 participants with quasi-randomized treatment order investigated the treatment effects of conversation and traditional stimulation treatments on conversational outcomes. Treatment was administered for 10 sessions (2 one-hour weekly sessions) per treatment type. Primary conversational outcomes included 6-minute conversations coded for pragmatic behaviors and percent Correct Information Units (CIUs). Traditional stimulation probes included auditory comprehension, lexical retrieval, and syntax probe performance. Secondary outcome measures represented the domains of the ICF (WHO, 2001) model with the addition of quality of life. These included the Western Aphasia Battery (Kertesz, 2007), the American Speech Language and Hearing Associations Functional Assessment of Communication Scale (Frattali, Holland, Thompson, Wohl, & Ferketic, 1995), the Conversation Analysis Profile for People with Aphasia (Whitworth, Perkins, & Lesser, 1997), and the Stroke and Aphasia Quality of Life Scale (Hilari, Byng, Lamping, & Smith, 2003). Results indicated there was a treatment effect for syntax abilities following traditional stimulation therapy for the participants who received this treatment first. The two participants who received traditional stimulation therapy first demonstrated improved conversational outcomes. The participant with moderate aphasia who received conversation therapy first demonstrated an effect for conversation therapy. Visual trends indicated three out of the four participants demonstrated the highest gains in conversational abilities during or following conversation therapy. Percent CIUs increased over time in three participants despite order of treatment. No significant group changes were demonstrated after traditional or conversation therapy on secondary outcome measures. These results provide a template for conducting and measuring conversational therapy.

Objective: The purpose of this study was to investigate the effects of two different prophylactic behavioral swallowing exercise regimens performed by head and neck cancer/s (HNC) patients during radiation therapy with/without chemotherapy (RT/C) on swallowing physiology, function, quality-of-life (QOL) and weight outcomes at the completion of RT/C. Feeding tube (PEG) status at 3 months post-treatment was also compared. Methods: This study was conducted via a prospective design. 50 patients diagnosed with HNC who were to undergo RT/C were recruited at pre-treatment based on the inclusion criteria: functional swallowing abilities; without prophylactic PEG tubes; ability to comprehend and perform therapy tasks and signed informed consent. Patients were assigned to the exercise group (EX: n=26) or repetitive swallow group (SW: n=24), by alternate assignment as well as matching for age, tumor site and stage. A no treatment group (NTx) of patients (n=23) was recruited retrospectively from co-facilities during identical timelines as the prospective cohort. The EX and SW treatment groups attended therapy sessions once a week and completed two different intensive exercise regimens throughout RT with maintenance of a daily home program. Outcome measures: All patients in the EX and SW treatment groups, underwent pre and post-treatment MBS studies. The following outcomes were reported: physiological (aspiration and Penetration Aspiration Scale scores); functional (PEG tube dependence and Functional Oral Intake Scale scores); QOL (MD Anderson Dysphagia Inventory Scale scores) and weight loss. At 3 months post-treatment, PEG tube dependence was assessed and compared. PEG tube dependence and weight loss in patients in the treatment and no treatment groups were compared at post-treatment and 3 months post-treatment. Results: The EX and SW groups did not statistically significantly differ on any outcomes at post-treatment. The NTx group also did not differ from the EX and SW groups in terms of PEG tube dependence and weight loss at post-treatment. However, the EX group exhibited a significantly higher rate of PEG tube elimination than the SW group at 3 months post-treatment (i.e. 16% vs. 50%). Among patients who received both radiation and chemotherapy, patients in the EX group exhibited significantly lower PEG tube dependence rates at post-treatment and 3 months post-treatment, compared to the SW and NTx groups. The EX groups post-treatment aspiration (i.e. 18%) and PEG tube dependence (16%) rates at 3 months post-treatment were among the lowest reported in the literature. Conclusions: Performing swallowing exercises prophylactically, resulted in significantly improved rates of PEG tube elimination and oral intake abilities. Findings indicated substantial benefits of the EX groups exercise regimen, encouraging its utility in the clinical setting. Although statistically non-significant, the SW group exhibited better outcomes than no therapy, warranting future investigations to explore the benefits of the SW exercise regimen.

Dysarthria refers to a group of neurogenic speech disorders which result in abnormal strength, speed, range, steadiness, tone, or accuracy of movements required for speech production. Although speech deficits of dysarthria are heterogeneous according to lesion sites and/or etiologies such as stroke, traumatic brain injury, cerebral palsy, Parkinsons disease (PD), imprecise consonants has been known as one of the most prominent and frequently occurring features of dysarthria, which subsequently contributes to decreased speech intelligibility. The present study points out the paucity of acoustic data on consonants produced by speakers with dysarthria, especially by spectral analysis, and reports four spectral moment analysis results on word initial stop consonants in six individuals with dysarthria and six age and gender matched healthy individuals. Each participant was asked to say a series of single words with a carrier phrase and a set of sentences. The initial 40ms of each single word was analyzed using TF32 to find the spectral moment values. Results suggest that the first spectral moment (M1) was the most useful in differentiating between the genders, healthy vs. dysarthria, and place of articulation, which is consistent with previous studies. This moment revealed that individuals with dysarthria have higher values compared to healthy individuals, which indicates that this speaker group tends to have a more anterior constriction for stop production. Along with this fronting pattern, the M1 ratios between adjacent stops were reduced for the speakers with dysarthria, which indicates reduced acoustic contrast for stop production. However, no correlation was found between the perceptual speech intelligibility estimates and the spectral characteristics.