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Call number: LD2668 .T4 1954 A7 / Master of Science

An objective measure, not requiring a behavioral response, of speech recognition performance in individuals with cochlear implants (CIs) would be beneficial in directing clinical recommendations. Neuroimaging can be such a measure but is difficult in the CI population. Functional near-infrared spectroscopy (fNIRS) is a non-invasive neuroimaging technique that is viable for CI recipients. This dissertation began to examine the potential of fNIRS in this population by determining the effects of speech recognition performance and stimulus intensity level on fNIRS recorded cortical activation. We hypothesized that fNIRS responses would be correlated with both intensity level and speech recognition performance. Thirteen adults with bilateral CIs and 16 adults with normal hearing were included in the study. Experiment one used signal-correlated noise to determine the effect of intensity level in the range of soft to loud speech (45-75 dB SPL). Experiment two used both signal-correlated noise and sentences presented in background babble at three different signal-to-noise ratios to determine the effect of speech recognition performance on cortical activity. fNIRS data were recorded in the left hemisphere. The experiment one showed a positive correlation of auditory cortical activation with stimulus intensity level in both groups. In contrast, experiment two revealed a difference between the groups. The adults with normal hearing had stronger activation in the auditory cortex, inferior frontal gyrus, and the inferior parietal lobe with higher speech recognition. In contrast, the CI group had the opposite effect with stronger activation in those same areas with lower speech recognition. The stimulus level results are consistent with the literature and out hypothesis. The results of the second experiment are consistent with our hypothesis and the literature in only the normal hearing group. This is the first study to use neuroimaging for speech recognition in noise in individuals with CIs. Research is needed to further examine cortical activation patterns for speech recognition in noise in these two groups. These results support the potential of fNIRS as a measure of speech recognition performance at a group level. The individual variability was large, however, and might limit the potential of fNIRS at an individual level.

<p> Acutely ill patients, across the age continuum, often present with complex communication needs (CCN) due to motor, sensory, cognitive and linguistic barriers they may experience during their hospital encounter. While hospital administrators recognize the importance of improving communication among the healthcare team members to increase quality and safety measures, few have focused on improving the patient-provider communication process, especially for patients with CCN. Recent Joint Commission standards mandates hospitals and healthcare providers improve communication for patients with CCN across all points of the care continuum. The study investigated the effectiveness of AAC training protocols for acute care nurses and ancillary healthcare providers using an on-line instructional medium for clinical skills teaching. The study design allowed for the measurement of learning following exposure to the tutorial and the analysis of possible clinical skill application. The current study invited a total of 377 nurses and graduate students to participate. Eight-three participated in the study and were divided randomly into two groups. Seventeen (20.5%) were assigned to in the control group, and 66 (79.5%) participants were into the test group. Both groups were directed to complete a pre-test measure. This was followed by exposure to the tutorial for the test group. The groups then were instructed to complete a post-test measure. For all participants in the test condition, the mean difference score (post-pre) was 19.2. The average pre-test score was 60.8 with a standard deviation of 12.4 while the average post-test score was 80.1 with a standard deviation of 11.3. This difference was significant (p&lt;.00001). This suggests the on-line tutorial as a mode of delivery for clinical skills teaching of AAC solutions for patients with CCN was effective. The study also involved the design of a set of scenarios to assess transfer of knowledge from the tutorial to clinical practice in a safe environment. The scenarios targeted three areas for participants to problem solve through: the development of a yes/no response, recognition of sensory issues displayed by patients with CCN; and, candidacy for AAC use in an acute care setting. The scenarios were presented to both groups after completion of the post-test measure. No significant difference across the groups was noted. However, findings suggested that the use of scenarios may be a viable method for assessing the application of clinical skills when the participant had to generate a narrative outlining clinical practice as opposed being scaffold by the selection of correct and incorrect clinical skill strategies presented. The study emphasizes the need to enhance the patient-provider communication experience for patients with CCN and outlines basic elements for nurse training modules.</p>

Tense marking at the point of school entry, that is, kindergarten, has been hypothesized to follow a bimodal distribution. Under this hypothesis, it is predicted that most children exhibit tense marking skills at or near the upper end of proficiency whereas some children demonstrate notably reduced proficiency. Due to this separation of skill level, kindergarten tense marking is considered a clinical marker for language impairment. The purpose of this study was to test the validity of a bimodal distribution of tense marking in a population-based sample of kindergarten students. The Test of Early Grammatical Impairment (TEGI) Screening Test was administered to three-quarters of the kindergarten students attending a school district of Mainstream American English speakers. Results revealed a distribution of TEGI Screening Test Scores that deviated significantly from normality. Cluster analysis indicated a best-fitting two-cluster solution that, upon inspection, generally aligned with bimodal-distribution expectations for typical and language-impaired classification prevalence rates and threshold values. Cross validation of child cluster membership to a reference standard for a subsample of participants offered further, albeit preliminary, evidence in support of the discriminant validity of assessing tense marking for the purpose of identifying language impairment in the general kindergarten population.

The purpose of this study was to describe return to school after sports-related concussion, including absences, academic performance, receipt of accommodations, and satisfaction of the parent/child with classroom accommodations and the return-to-school experience. We conducted telephone surveys of 83 families (78 parent-child dyads, 5 parents) a median of 276 days following concussion. Students missed a median of 2 days of school following concussion. There was a positive relationship between number of reported school-related problems and absences in the child-reported data only. There was a positive relationship between number of absences and symptom severity in both the parent and child-reported data. Return to academic baseline was reported by 86.7% of parents and 92.3% of children. Return to academic baseline was more likely in children with fewer school-related problems per parent report, and more likely in younger students and those with a lower symptom severity scores per child report. Academic accommodations were provided to 73.5% of children per parent report and 76.9% of children per child report. Receipt of accommodations was related to parent communication with the school, physician recommendation for accommodations, number of post-concussion school-related problems, and increased absences per parent report. No relationships were found between receipt of accommodations and investigated variables in the child-reported data. The majority of parents (81.9%) and children (82.1%) reported being satisfied with the schoolâs response to accommodating the childâs needs following concussion. Satisfaction with receipt of accommodations was higher for children who received accommodations and/or who returned to academic baseline, according to both parent and child-reported data. Parent income was positively associated with satisfaction with accommodations in the parent-reported data only. Similarly, 89.2% of parents and 85.9% of children reported being satisfied with the overall return-to-school experience. Satisfaction with the overall return-to-school experience was related to receipt of accommodations in both the parent and child-reported data, but was related to return to academic baseline only in the child-reported data. There was no significant relationship between other investigated variables and satisfaction outcomes. Findings highlight the continued need for policies and education of stakeholders to insure appropriate academic management of concussions in students.

<p> The purpose of this study was to evaluate the effects of a social participation based aphasia treatment called conversational coaching. Conversational coaching involves teaching individuals with aphasia and their communication partners (e.g., spouses/caregivers) strategies to facilitate more efficient and meaningful conversation. Two dyads participated in a multiple baseline experimental design across subjects. During baseline sessions, the individual with aphasia watched a videotaped story and then attempted to communicate the story&rsquo;s content to his/her spouse. During treatment sessions, the same general procedure was used, but the investigator coached both participants in the use of selected communicative strategies to facilitate transmission of information and improve the quality of their conversations. The primary dependent variable was the percentage of main concepts successfully co-constructed during conversations. In addition, social outcome measures were used to evaluate the treatment&rsquo;s impact on communicative confidence and quality of life. Positive outcomes were obtained for both dyads</p>

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