The purpose of this study was to examine whether or not the method of reading (either aloud or silently) would affect the reading comprehension performance of left hemispheredamaged (LHD) and non-brain-damaged (NBD) subjects across inference levels using the Nelson Reading Skills Test (NRST) (Hanna, Schell, & Schreiner, 1977). The experimental group was comprised of fifteen subjects who had suffered a cerebrovascular accident (CVA) to the left hemisphere of the brain. Subjects were selected after they had demonstrated an adequate level of function on the Short Porch Index of Conununicative Ability (SPICA) (DiSimoni, Keith, & Darley, 1980), to perform the tasks required in this study. Subjects were then randomly assigned to either "left hemispheredamaged aloud reading" or "left hemisphere-damaged silent reading" subgroups. The non-brain-damaged (NBD) control group consisted of fifteen individuals with no known history of neurological impairment. Control group subjects were also randomly assigned to either the "non-brain damaged aloud reading" subgroup or the "non-brain damaged silent reading" subgroup. All subjects were administered the revised version of the Nelson Reading Skills Test (NRST) (1977), Form 4 of Level B. NRST test questions can be grouped into three categories representing literal, translational, and high levels of inference. Subjects were required to read five paragraphs and answer thirty-three questions pertaining to the reading material by pointing to the correct answer from a list of four choices. Subjects were allowed to refer back to the paragraph when attempting to answer test questions. Results revealed total NRST performance to be significantly better for NBD subjects. Within both experimental and control groups, no significant difference was found to exist between the test scores of the oral and silent reading subgroups. The research data did not reflect the expected error pattern of most errors occurring on high inference level questions and fewest errors on literal inferences for either group of subjects.

This New Zealand study used a grounded theory methodology to explore the day-to-day occupations of family caregiving for children who had sustained a traumatic brain injury. Semi-structured interviews and participant observations were employed to gather data from five families including children of pre-school and school age and their parents. Constant comparative analysis of the data revealed a central caregiving category, Structuring For Security, which encompassed two simultaneous and interdependent caregiving processes. A model is presented illustrating the processes.Structuring For Security describes the way the parents' caregiving is directed towards building a framework that provides for the present and future safety and success of their children. Holding Things Together explains endeavours to contain the distressing events resulting from the accident, with a focus on protecting the children from physical and emotional dangers. Joining My Child With Others explains what is happening when parents set things up for their children to spend time in activity with other people. The two processes are mediated by support from others, and involve learning and use of practical knowledge about the child. Successful implementation of the processes results in parents' increasing awareness of their ability to cope, progress in the children, and children's successful participation with other people. Participation in the processes is ongoing, responding to change in the child and in the environment.The study findings suggest a basis for the development of a framework that families and clinicians might use to guide caregiving for children after a traumatic brain injury. The findings also indicate the importance of supporting parents in developing effective caregiving structures that fit with their concerns for their children's safety and success with others. Consideration needs to be given to policies that take into account the safety issues involved for children and the support needs of parents following the accident.

published_or_final_version / Speech and Hearing Sciences / Doctoral / Doctor of Philosophy

Large neocortical lesions, such as hemidecortication, are detrimental for motor and cognitive skills. This thesis investigates the effect of age at the time of lesion on functional outcome. Attempts were then made to improve the outcome by using two simple treatments, tactile stimulation and Fibroblast Growth Factor-2 (FGF-2). The functional outcome of animals was measured using a series of behavioural tests (Morris water task, skilled reaching, forelimb placing during spontaneous vertical exploration, and the sunflower seed task). A qualitative difference was noted between animals that received hemidecortication at post natal day ten (P 10) versus animals that received a hemidecortication in adulthood (postnatal day, P 90). When the tactile stimulation treatment was used on animals that received P 10 hemidecortication, cognitive and motor improvements were noted. The same was not true for injections of FGF-2. When given after P 10 hemidecortication, this treatment impaired the cognitive abilities of rats in the Morris water task. There are two main points from this project: 1) overall functional recovery is not better or worse but simply different based on the age at which the trauma occurred and 2) treatments have varied success with different types of brain injury. / x, 123 leaves ; 29 cm.

This New Zealand study used a grounded theory methodology to explore the day-to-day occupations of family caregiving for children who had sustained a traumatic brain injury. Semi-structured interviews and participant observations were employed to gather data from five families including children of pre-school and school age and their parents. Constant comparative analysis of the data revealed a central caregiving category, Structuring For Security, which encompassed two simultaneous and interdependent caregiving processes. A model is presented illustrating the processes.Structuring For Security describes the way the parents' caregiving is directed towards building a framework that provides for the present and future safety and success of their children. Holding Things Together explains endeavours to contain the distressing events resulting from the accident, with a focus on protecting the children from physical and emotional dangers. Joining My Child With Others explains what is happening when parents set things up for their children to spend time in activity with other people. The two processes are mediated by support from others, and involve learning and use of practical knowledge about the child. Successful implementation of the processes results in parents' increasing awareness of their ability to cope, progress in the children, and children's successful participation with other people. Participation in the processes is ongoing, responding to change in the child and in the environment.The study findings suggest a basis for the development of a framework that families and clinicians might use to guide caregiving for children after a traumatic brain injury. The findings also indicate the importance of supporting parents in developing effective caregiving structures that fit with their concerns for their children's safety and success with others. Consideration needs to be given to policies that take into account the safety issues involved for children and the support needs of parents following the accident.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 6 uppsatser.

Afhandling, Linköpings universitet, 2007.

Studies of sustained-attention retraining following brain injury are reviewed, and found to have produced inconclusive results. The reason for this, it is suggested, is that a standard operational analysis of attention has not been applied, as evidenced by considerable inconsistency in the dependent measures and treatment methods used from study to study. The present study addresses this concern by applying well established principles of operant conditioning to the analysis and remediation of attention deficits. After briefly reviewing the variety of task parameters in the attention literature, noting ambiguities inherent in the various conceptualizations of attention, it is decided to train vigilance task performance, a relatively unambiguous and uncontroversial operational definition of sustained attention. Both the principle of immediacy, of reinforcement (feedback of correct and incorrect on each trial) and shaping (gradual increase of speed demands contingent on increased performance accuracy) are employed. The issue of generalization is deemed central to concerns of treatment efficacy, and is explored by administration of alternate versions of the same basic vigilance task. Results show that training with immediate reinforcement and speed-shaping produced better acquisition of the trained task than delayed feedback and invariant speed of stimulus presentation. Furthermore, gains resulting from training were essentially limited to the task on which training was conducted, with little evidence for generalization to like tasks employing different stimuli. These results are discussed in terms of the applicability of the construct of sustained attention to head injury rehabilitation. / Graduate

As especializações do hemisfério direito (HD) no processamento da função lingüística e da comunicação vêm ganhando destaque na literatura internacional, sendo ainda pouco conhecidas no contexto nacional. Conseqüentemente, há, ainda, limitados procedimentos de avaliação neuropsicológica dos distúrbios comunicativos apresentados em quadros de lesões desse hemisfério. Frente a essa demanda de ferramentas diagnósticas, a presente pesquisa teve por objetivo promover estudos teóricos e empíricos com a Bateria Montréal de Avaliação da Comunicação – Bateria MAC, versão Brasileira do instrumento canadense Protocole Montreal d’Évaluation de la Communication – Protocole MEC, analisando-se o processamento de habilidades comunicativas de ativação do HD em adultos não lesados e em indivíduos com lesão vascular nesse lado do cérebro. Essa tese está composta por quatro estudos teóricos, com os objetivos de verificar quais os indícios do papel do HD no processamento comunicativo em estudos de neuroimagem com indivíduos neurologicamente preservados (Estudo teórico 1), apresentar uma meta-análise de estudos com indivíduos com lesão vascular no HD, investigando-se o desempenho desta população no processamento comunicativo (Estudo teórico 2), apresentar uma revisão teórica sobre a avaliação neuropsicológica da linguagem após lesão cerebral, com ênfase nas avaliações funcionais (Estudo teórico 3) e promover uma caracterização da Síndrome do HD (Estudo teórico 4). Além disso, a tese também está formada por três estudos empíricos, que visam a verificar o efeito de variáveis sócio-demográficas no desempenho comunicativo avaliado pela Bateria MAC (Estudo empírico 1), a apresentar normas de desempenho quanto à idade e à escolaridade, assim como dados da fidedignidade desse instrumento (Estudo empírico 2) e a averiguar o desempenho de lesados de HD nas tarefas comunicativas da Bateria MAC, comparando-os com um grupo controle (Estudo empírico 3). Como resultados, os estudos teóricos 1 e 2 mostraram uma importante contribuição do HD no processamento comunicativo tanto em indivíduos neurologicamente saudáveis quanto em indivíduos com lesões cerebrais direitas. O estudo teórico 3 evidenciou um crescente interesse pelo exame dos aspectos funcionais. O quarto estudo caracterizou os principais sintomas cognitivos (anosognosia, heminegligência sensorial, prosopagnosia, alterações de memória visuo-espacial e de trabalho, dispraxia construtiva e disfunção executiva), comunicativos (alterações nos componentes discursivo, pragmático-inferencial, léxico-semântico e prosódico) e comportamentais (dificuldades de compreensão e produção de emoções faciais e vocais e alterações neuropsiquiátricas) da Síndrome do HD. No estudo empírico 1, foram verificados efeitos das variáveis idade e escolaridade em tarefas dos quatro processamento avaliados pela Bateria MAC, sendo o efeito da educação mais significativo. O estudo empírico 2 apresentou normas quanto à idade e à escolaridade e demonstrou uma adequada fidedignidade do instrumento investigado. Por fim, no estudo 3 observou-se efeito da lesão de HD em tarefas discursivas, pragmáticas, léxico-semânticas e prosódicas, além de uma menor homogeneidade do grupo clínico quando comparado ao controle. / Right hemisphere (RH) specializations related to language and communication functions have been focused in international literature, although they are nationally less known. Consequently, there still are reduced neuropsychological assessment procedures to evaluate communication disorders present in right brain damage. Taking this great demand of diagnosis tools into account, this research aimed to present theoretical and empirical studies with the Brazilian version of Montreal Communication Evaluation Battery – Protocole MEC, analyzing the process of communicative abilities related to RH’s activation in non-damaged adults and in individuals with a stroke in this hemisphere. This thesis is formed by four theoretical studies, with the aims to verify the literature index to right hemisphere role on communicative processing in neuroimaging studies with neurologically normal participants (Theoretical study 1), to present a meta-analysis of studies with right brain damaged participants, verifying their communicative processing (Theoretical study 2), to present a theoretical review about the language neuropsychological assessment after brain damage, emphasizing the functional evaluation (Theoretical study 3) and to promote a description of the RH Syndrome (Theoretical study 4). Moreover, the thesis also includes three empirical investigations, witch aim to verify demographic factors’ effects on communication performance evaluated by Protocole MEC (Empirical study 1), to present norms related to age and education, as well as reliability data (Empirical study 2) and to investigate right brain damaged communication performance in Protocole MEC’s tasks, comparing this clinical group with a control one (Empirical study 3). As results, theoretical studies 1 and 2 showed an important contribution of the right hemisphere to communication process in healthy and right brain damaged subjects. In the theoretical study 3, a growing interest in the evaluation of language functional components was observed. The fourth study characterized the main RH Syndrome’s cognitive symptoms (anosognosia, hemineglect, prosopagnosia, working and visual-spatial memory disorders, constructional dyspraxia and executive dysfunction), communication symptoms (discoursive, pragmatic, lexical-semantic 12 and prosodic deficits) and behavioral symptoms (difficulties in comprehension and production of facial and vocal expression, as well as neuropsychiatric disorders). In the empirical study 1, age and schooling effects were noted in tasks that evaluate the four communication components covered by the Protocole MEC. The education effect was more significant than the age one. The empirical study 2 presented norms stratified by age and education and it showed that Protocole MEC is a reliable instrument. In the study 3, a right brain damage effect was observed in discursive, pragmatic, lexical-semantic and prosodic tasks, followed by a less homogeneous performance of the clinical group compared to the control one.

As especializações do hemisfério direito (HD) no processamento da função lingüística e da comunicação vêm ganhando destaque na literatura internacional, sendo ainda pouco conhecidas no contexto nacional. Conseqüentemente, há, ainda, limitados procedimentos de avaliação neuropsicológica dos distúrbios comunicativos apresentados em quadros de lesões desse hemisfério. Frente a essa demanda de ferramentas diagnósticas, a presente pesquisa teve por objetivo promover estudos teóricos e empíricos com a Bateria Montréal de Avaliação da Comunicação – Bateria MAC, versão Brasileira do instrumento canadense Protocole Montreal d’Évaluation de la Communication – Protocole MEC, analisando-se o processamento de habilidades comunicativas de ativação do HD em adultos não lesados e em indivíduos com lesão vascular nesse lado do cérebro. Essa tese está composta por quatro estudos teóricos, com os objetivos de verificar quais os indícios do papel do HD no processamento comunicativo em estudos de neuroimagem com indivíduos neurologicamente preservados (Estudo teórico 1), apresentar uma meta-análise de estudos com indivíduos com lesão vascular no HD, investigando-se o desempenho desta população no processamento comunicativo (Estudo teórico 2), apresentar uma revisão teórica sobre a avaliação neuropsicológica da linguagem após lesão cerebral, com ênfase nas avaliações funcionais (Estudo teórico 3) e promover uma caracterização da Síndrome do HD (Estudo teórico 4). Além disso, a tese também está formada por três estudos empíricos, que visam a verificar o efeito de variáveis sócio-demográficas no desempenho comunicativo avaliado pela Bateria MAC (Estudo empírico 1), a apresentar normas de desempenho quanto à idade e à escolaridade, assim como dados da fidedignidade desse instrumento (Estudo empírico 2) e a averiguar o desempenho de lesados de HD nas tarefas comunicativas da Bateria MAC, comparando-os com um grupo controle (Estudo empírico 3). Como resultados, os estudos teóricos 1 e 2 mostraram uma importante contribuição do HD no processamento comunicativo tanto em indivíduos neurologicamente saudáveis quanto em indivíduos com lesões cerebrais direitas. O estudo teórico 3 evidenciou um crescente interesse pelo exame dos aspectos funcionais. O quarto estudo caracterizou os principais sintomas cognitivos (anosognosia, heminegligência sensorial, prosopagnosia, alterações de memória visuo-espacial e de trabalho, dispraxia construtiva e disfunção executiva), comunicativos (alterações nos componentes discursivo, pragmático-inferencial, léxico-semântico e prosódico) e comportamentais (dificuldades de compreensão e produção de emoções faciais e vocais e alterações neuropsiquiátricas) da Síndrome do HD. No estudo empírico 1, foram verificados efeitos das variáveis idade e escolaridade em tarefas dos quatro processamento avaliados pela Bateria MAC, sendo o efeito da educação mais significativo. O estudo empírico 2 apresentou normas quanto à idade e à escolaridade e demonstrou uma adequada fidedignidade do instrumento investigado. Por fim, no estudo 3 observou-se efeito da lesão de HD em tarefas discursivas, pragmáticas, léxico-semânticas e prosódicas, além de uma menor homogeneidade do grupo clínico quando comparado ao controle. / Right hemisphere (RH) specializations related to language and communication functions have been focused in international literature, although they are nationally less known. Consequently, there still are reduced neuropsychological assessment procedures to evaluate communication disorders present in right brain damage. Taking this great demand of diagnosis tools into account, this research aimed to present theoretical and empirical studies with the Brazilian version of Montreal Communication Evaluation Battery – Protocole MEC, analyzing the process of communicative abilities related to RH’s activation in non-damaged adults and in individuals with a stroke in this hemisphere. This thesis is formed by four theoretical studies, with the aims to verify the literature index to right hemisphere role on communicative processing in neuroimaging studies with neurologically normal participants (Theoretical study 1), to present a meta-analysis of studies with right brain damaged participants, verifying their communicative processing (Theoretical study 2), to present a theoretical review about the language neuropsychological assessment after brain damage, emphasizing the functional evaluation (Theoretical study 3) and to promote a description of the RH Syndrome (Theoretical study 4). Moreover, the thesis also includes three empirical investigations, witch aim to verify demographic factors’ effects on communication performance evaluated by Protocole MEC (Empirical study 1), to present norms related to age and education, as well as reliability data (Empirical study 2) and to investigate right brain damaged communication performance in Protocole MEC’s tasks, comparing this clinical group with a control one (Empirical study 3). As results, theoretical studies 1 and 2 showed an important contribution of the right hemisphere to communication process in healthy and right brain damaged subjects. In the theoretical study 3, a growing interest in the evaluation of language functional components was observed. The fourth study characterized the main RH Syndrome’s cognitive symptoms (anosognosia, hemineglect, prosopagnosia, working and visual-spatial memory disorders, constructional dyspraxia and executive dysfunction), communication symptoms (discoursive, pragmatic, lexical-semantic 12 and prosodic deficits) and behavioral symptoms (difficulties in comprehension and production of facial and vocal expression, as well as neuropsychiatric disorders). In the empirical study 1, age and schooling effects were noted in tasks that evaluate the four communication components covered by the Protocole MEC. The education effect was more significant than the age one. The empirical study 2 presented norms stratified by age and education and it showed that Protocole MEC is a reliable instrument. In the study 3, a right brain damage effect was observed in discursive, pragmatic, lexical-semantic and prosodic tasks, followed by a less homogeneous performance of the clinical group compared to the control one.